Provider Demographics
NPI:1518852599
Name:BUCKLAND, RACQUEL M
Entity type:Individual
Prefix:
First Name:RACQUEL
Middle Name:M
Last Name:BUCKLAND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 SEABROOK RD
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:GA
Mailing Address - Zip Code:30620-2173
Mailing Address - Country:US
Mailing Address - Phone:678-477-5940
Mailing Address - Fax:
Practice Address - Street 1:51 SEABROOK RD
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:GA
Practice Address - Zip Code:30620-2173
Practice Address - Country:US
Practice Address - Phone:678-477-5940
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-10
Last Update Date:2025-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA297925363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner