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General NPI Number Information
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NPI Number | 1306713391
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Entity Type | Individual
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Provider Name | ANDREA BUCKINGHAM
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Gender | Female
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Dates
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Enumeration Date | 10/22/2025
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Last Update Date | 04/08/2026
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Provider Practice Location Address
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Address Line | 430 WINDWARD WAY STE 100
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City | KALISPELL
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State | MT
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Zip | 59901-2619
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Country | US
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Telephone | 406-758-1867
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Fax |
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Provider Business Mailing Address
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Address Line | 745 E OREGON ST
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City | KALISPELL
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State | MT
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Zip | 59901-3206
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Country | US
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Telephone |
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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 | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 59718
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License Number State | MT
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