Healthcare Provider Details

I. General information

NPI: 1235527763
Provider Name (Legal Business Name): REBECCA BUCHANAN NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/06/2015
Last Update Date: 09/16/2025
Certification Date: 09/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1106 HAZEL LN
FARMINGTON MO
63640-1999
US

IV. Provider business mailing address

PO BOX 959318
SAINT LOUIS MO
63195-7683
US

V. Phone/Fax

Practice location:
  • Phone: 573-756-6751
  • Fax: 573-760-8044
Mailing address:
  • Phone: 573-468-1997
  • Fax: 573-468-1998

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number2014043969
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2014043969
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: