Individual
KAITLIN BUCKNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.
Contact information
Practice address
6043 HUDSON RD STE 220, WOODBURY, MN 55125-1033
(651) 925-8200
(651) 925-8201
Mailing address
64 TOUCHSTONE, LAKE OSWEGO, OR 97035-1909
(702) 994-4332
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
10495
MN
363A00000X
Physician Assistant
1414
OK
363A00000X
Physician Assistant
3127
AZ
363A00000X
Physician Assistant
6669778-1206
UT
363A00000X
Physician Assistant
PA223121
OR
363A00000X
Physician Assistant
PA65471
CA
363A00000X
Physician Assistant
PADA1230
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
20047220A
—
OK
Enumeration date
06/23/2006
Last updated
05/18/2025
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