Organization
GUMTREE MENTAL HEALTH & WELLNESS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KYRIA A BUCHANAN PMHNP-BC, APRN (NURSE PRACTITIONER)
(813) 838-2707
Entity
Organization
Contact information
Practice address
520 FULLERTON RD STE B, SWANSEA, IL 62226-2901
(618) 277-0006
Mailing address
405 N LINCOLN AVE, O FALLON, IL 62269-1322
(813) 838-2707
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Enumeration date
09/09/2024
Last updated
09/09/2024
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