Basic Information
Provider Information
NPI: 1013420116
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: DUKE
FirstName: EMILY
MiddleName: BUCKNER
NamePrefix:  
NameSuffix:  
Credential: CRNP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 55310
Address2:  
City: BIRMINGHAM
State: AL
PostalCode: 352555310
CountryCode: US
TelephoneNumber: 2057319701
FaxNumber: 2052979411
Practice Location
Address1: 619 19TH STREET S
Address2:  
City: BIRMINGHAM
State: AL
PostalCode: 352491900
CountryCode: US
TelephoneNumber: 2059344011
FaxNumber:  
Other Information
ProviderEnumerationDate: 11/10/2017
LastUpdateDate: 08/04/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 08/02/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LG0600X1-141653ALY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
363LA2100X1-141653ALN Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care

No ID Information.


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