Active NPI
Lisa Buckley, SLP
- Speech-Language Pathologist
- Panama City, FL
National Provider Identifier
1407092703
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- SA4507
- Practice address
- 927 Grace Ave
Panama City, FL 32401-2521 - Phone
- (850) 769-5371
- Fax
- (850) 872-9558
- NPI assigned
- Dec 17, 2008
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | SA4507 | FL | Primary |
Addresses
Primary practice location
927 Grace Ave
Panama City, FL 32401-2521
Mailing address
927 Grace Ave
Panama City, FL 32401-2521
Phone (850) 769-5371
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000611900 | Medicaid | FL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| SA4507 | FL | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1229472000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1236211200000",
"number": "1407092703",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "927 GRACE AVE",
"city": "PANAMA CITY",
"state": "FL",
"postal_code": "324012521",
"telephone_number": "850-769-5371",
"fax_number": "850-872-9558"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "927 GRACE AVE",
"city": "PANAMA CITY",
"state": "FL",
"postal_code": "324012521",
"telephone_number": "850-769-5371",
"fax_number": "850-872-9558"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BUCKLEY",
"first_name": "LISA",
"credential": "SLP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-12-17",
"last_updated": "2009-03-05",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "FL",
"license": "SA4507",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "000611900",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Panama City, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.