Dalton Buckman

Individual provider Active NPI Student in an Organized Health Care Education/Training Program · Mocksville, NC

NPI 1811569726 · NPPES record last updated Jul 12, 2021

Key facts

NPI
1811569726
Entity type
Individual (NPI type 1)
Primary specialty
Student in an Organized Health Care Education/Training Program 390200000X
Practice address
186 Linda LN
Mocksville, NC 27028-9400
Phone
(309) 371-8822
NPI assigned
Jul 12, 2021
Sex
Male
Sole proprietor
Yes

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Athletic Trainer 2255A2300X
Student in an Organized Health Care Education/Training Program 390200000X Yes

Addresses

Primary practice location

186 Linda LN
Mocksville, NC 27028-9400

Mailing address

1 University Pkwy
High Point, NC 27268-0002

Other providers in Mocksville, NC

All providers in Mocksville, NC · Student in an Organized Health Care Education/Training Program in North Carolina

Sources for this page

Verify at the official NPI Registry.