Provider Demographics
NPI:1013809748
Name:BUCKNER, REBECCA (PHYSICIAN ASSISTANT)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:BUCKNER
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12825 VILLA MILANO DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76126-6114
Mailing Address - Country:US
Mailing Address - Phone:817-946-8385
Mailing Address - Fax:
Practice Address - Street 1:450 W MEDICAL CENTER BLVD STE 600
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-4233
Practice Address - Country:US
Practice Address - Phone:832-390-5434
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-17
Last Update Date:2025-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical