Provider Demographics
NPI:1942193479
Name:BUCK, CONNER (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:CONNER
Middle Name:
Last Name:BUCK
Suffix:
Gender:M
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3900 SOUTHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:KOKOMO
Mailing Address - State:IN
Mailing Address - Zip Code:46902-3689
Mailing Address - Country:US
Mailing Address - Phone:765-453-7422
Mailing Address - Fax:765-453-3773
Practice Address - Street 1:3900 SOUTHLAND AVE
Practice Address - Street 2:
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46902-3689
Practice Address - Country:US
Practice Address - Phone:765-453-7422
Practice Address - Fax:765-453-3773
Is Sole Proprietor?:No
Enumeration Date:2025-06-02
Last Update Date:2025-06-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN71016673A363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health