Jacquelyn A Buckley, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

010844 Issued in NY

Practice address

1299 Route 9
Gansevoort, NY 12831-1560

Phone

(518) 761-6961

Fax

(518) 761-1006

NPI assigned

Aug 1, 2006

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

Other identifiers 1

Other names 1

• Jacquelyn A Delisle Former name

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in NY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

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

• Hudson Headwaters Health Network

  • Primary Care Clinic/Center
  • Warrensburg, NY
  • NPI 1194738344
  Medicare reassignment
• Hudson Headwaters Health Network

  • Primary Care Clinic/Center
  • Mineville, NY
  • NPI 1902900111

  Physician Assistant

  NPD
• Hudson Headwaters Health Network

  • Primary Care Clinic/Center
  • Salem, NY
  • NPI 1982417119

  Physician Assistant

  NPD
• Glens Falls Pediatric Consultants, PC

  • Pediatrics Physician
  • Glens Falls, NY
  • NPI 1598720369
  NPD (past)
• Hudson Headwaters Health Network

  • Primary Care Clinic/Center
  • Champlain, NY
  • NPI 1245285170
  NPD (past)

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

{
    "created_epoch": "1154390400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1767052800000",
    "number": "1871500165",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9 CAREY RD",
            "city": "QUEENSBURY",
            "state": "NY",
            "postal_code": "128047880",
            "telephone_number": "518-761-0300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1299 ROUTE 9",
            "city": "GANSEVOORT",
            "state": "NY",
            "postal_code": "128311560",
            "telephone_number": "518-761-6961",
            "fax_number": "518-761-1006"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BUCKLEY",
        "first_name": "JACQUELYN",
        "middle_name": "A",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-01",
        "last_updated": "2025-12-30",
        "certification_date": "2025-12-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "010844",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03160905",
            "state": "NY"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jacquelyn.buckley.1@1823.direct.athenahealth.com",
            "affiliation": "N",
            "address_1": "1299 Route 9",
            "city": "Gansevoort",
            "state": "NY",
            "country_code": "US",
            "postal_code": "128311560",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "JACQUELYN",
            "last_name": "DELISLE",
            "middle_name": "A",
            "credential": "PA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Jacqueline Nicolette Battista, PA
• Richard Boehler, MD
• Carrie L Braun
• McKenzie Broekstra, LSW; LMSW
• Lorraine L Bruce, LPN
• Nicole Marie Byrne, DMD
• Lisa Marie Cartier, CERTIFIED DOULA
• Lindsay Castiglione, IBCLC
• Emanuel Cirenza
• Debra Lee Collette, OTR/L

• Physician Assistant in Gansevoort, NY
• Providers in Gansevoort, NY by specialty
• Physician Assistant in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 30, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.