Healthcare Provider Details

I. General information

NPI: 1962754291
Provider Name (Legal Business Name): KAREN S BUCHANAN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2012
Last Update Date: 02/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 SKYLINE DR
RUSSELLVILLE AR
72801-3363
US

IV. Provider business mailing address

105 SKYLINE DR
RUSSELLVILLE AR
72801-3363
US

V. Phone/Fax

Practice location:
  • Phone: 479-968-2345
  • Fax: 479-890-7125
Mailing address:
  • Phone: 479-968-2345
  • Fax: 479-890-7125

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberP00168
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: