Individual
JONATHAN PARK BUCKWALTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
FNP-C
Contact information
Practice address
3075 N WINDSONG DR STE A, PRESCOTT VALLEY, AZ 86314-1208
(928) 350-8780
Mailing address
PO BOX 26568, PRESCOTT VALLEY, AZ 86312-6568
(928) 778-1251
(928) 778-7834
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN174745
AZ
363LF0000X
Family Nurse Practitioner
Primary
AP10723
AZ
Other
Enumeration date
10/20/2017
Last updated
07/30/2020
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