Dominique Jaquetta Nicole Buckner

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

337392 Issued in MS

Practice address

655 Meadowbrook Rd
Jackson, MS 39206-5842

Phone

(601) 882-4878

NPI assigned

May 20, 2022

Last updated

Mar 20, 2023By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Millennial Healthcare, LLC

  dba Millennial Healthcare

  • Nursing Care Agency
  • Jackson, MS
  • NPI 1437852266
  NPD Authorized official

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

{
    "created_epoch": "1653004800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1679270400000",
    "number": "1508504515",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "655 MEADOWBROOK RD",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392065842",
            "telephone_number": "601-882-4878"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "655 MEADOWBROOK RD",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392065842",
            "telephone_number": "601-882-4878"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BUCKNER",
        "first_name": "DOMINIQUE",
        "middle_name": "JAQUETTA NICOLE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-05-20",
        "last_updated": "2023-03-20",
        "certification_date": "2023-03-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "MS",
            "license": "337392",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Christen H Buckley, NP-C
• Evan Anthony Buckley, DO
• Buckner Prosthetic and Orthotic Laboratories Inc.
• Anna Michelle Buckner, LPC
• Deyanna Buckner
• Ernest W Bueche II, ATC
• Maria Ximena Bueno, M.D.
• Lauren Whitton Buffington, NP-C
• Dinah Marie Bufkin, LPC
• Patrick Barrett Bufkin

• Licensed Practical Nurse in Jackson, MS
• Providers in Jackson, MS by specialty
• Licensed Practical Nurse in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 20, 2023; 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.