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General NPI Number Information
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NPI Number | 1104852094
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Entity Type | Individual
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Provider Name | KAITLIN BUCKNER P.A.
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Gender | Female
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Dates
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Enumeration Date | 06/23/2006
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Last Update Date | 05/18/2025
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Provider Practice Location Address
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Address Line | 6043 HUDSON RD STE 220
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City | WOODBURY
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State | MN
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Zip | 55125-1033
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Country | US
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Telephone | 651-925-8200
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Fax | 651-925-8201
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Provider Business Mailing Address
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Address Line | 64 TOUCHSTONE
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City | LAKE OSWEGO
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State | OR
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Zip | 97035-1909
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Country | US
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Telephone | 702-994-4332
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 6669778-1206
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License Number State | UT
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 3127
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License Number State | AZ
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 1414
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License Number State | OK
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Taxonomy #4
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA223121
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License Number State | OR
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Taxonomy #5
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PADA1230
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License Number State | AK
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Taxonomy #6
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA65471
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License Number State | CA
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Taxonomy #7
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 10495
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License Number State | MN
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