MEDICARE: KIRSTI BUCKENDORF PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant		AZ
2	363A00000X	Physician Assistant	8034	AZ

General Provider Information

NPI Number	:	1487271078
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIRSTI BUCKENDORF PA

Provider Business Mailing Address
First Line	:	3311 N LAMAR BLVD
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78705-2016
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3311 N LAMAR BLVD
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78705-2016
Country	:	US
Telephone Number	:	512-975-7791
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/29/2020
Last Update Date	:	05/11/2022

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Directions to “ KIRSTI BUCKENDORF PA” Practice Location

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