Healthcare Provider Details

I. General information

NPI: 1699656181
Provider Name (Legal Business Name): KYLE BUCKNER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2025
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 E MARKET AVE BOX 12265
SEARCY AR
72149-0001
US

IV. Provider business mailing address

915 E MARKET AVE BOX 12265
SEARCY AR
72149-0001
US

V. Phone/Fax

Practice location:
  • Phone: 501-279-4475
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WR0400X
TaxonomyRehabilitation Registered Nurse
License Number227881
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number227881
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: