Gwendoria Buckles

Primary specialty

Psychiatric/Mental Health Registered NurseTaxonomy code 163WP0808X

License

811867 Issued in CA

Practice address

720 Wood St
Eureka, CA 95501

Phone

(707) 268-2990

NPI assigned

Aug 12, 2008

Last updated

Jan 9, 2019By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1218499200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1546992000000",
    "number": "1407002207",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "720 WOOD ST",
            "city": "EUREKA",
            "state": "CA",
            "postal_code": "955014413",
            "telephone_number": "707-268-2990"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "720 WOOD ST",
            "city": "EUREKA",
            "state": "CA",
            "postal_code": "95501",
            "telephone_number": "707-268-2990"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "720 Wood St",
            "address_purpose": "LOCATION",
            "city": "Eureka",
            "state": "CA",
            "postal_code": "95501",
            "country_code": "US",
            "telephone_number": "707-268-2990",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BUCKLES",
        "first_name": "GWENDORIA",
        "name_prefix": "Ms.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-08-12",
        "last_updated": "2019-01-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "LA",
            "license": "RN067802",
            "primary": false
        },
        {
            "code": "163WP0808X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Psychiatric/Mental Health",
            "state": "CA",
            "license": "811867",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LA STATE BOARD OF NURSING",
            "identifier": "RN067802",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Stacey McKinnie Brown
• Lynda S Bruce, PHD
• Stephen Michael Brudney, CASE MANAGER
• Chanel Marie Brumett, RN
• Candy S Bryant
• Maura Thoenes Buckley, PA-C
• Christine Buckner, RDH
• John Buechner, D.C.
• Anne Michelle Buffington
• Jenny Bugnacki

• Psychiatric/Mental Health Registered Nurse in Eureka, CA
• Providers in Eureka, CA by specialty
• Psychiatric/Mental Health Registered Nurse in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.