KAITLIN BUCKNER P.A. NPI 1104852094

NPI Information

  • NPI: 1104852094
  • Provider Name: KAITLIN BUCKNER, P.A.
  • Classification: Physician Assistant - 363A00000X
  • Entity Type: Individual
  • PECOS Registration: Yes
  • Address: 6043 HUDSON RD STE 220
    WOODBURY, MN
    ZIP 55125
  • Phone: (651) 925-8200

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NPI Details

Kaitlin Buckner, P.A. is a physician assistant in Woodbury, MN with 22 years of experience. The provider is a physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. Kaitlin Buckner, P.A. NPI is 1104852094. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

6043 HUDSON RD STE 220
WOODBURY, MN
ZIP 55125-033
Phone: (651) 925-8200
Fax: (651) 925-8201

The NPI 1104852094 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 6/23/2006 and was last updated on 5/18/2025.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1363A00000XPhysician Assistant6669778-1206UTAHNo
2363A00000XPhysician Assistant3127ARIZONANo
3363A00000XPhysician Assistant1414OKLAHOMANo
4363A00000XPhysician AssistantPA223121OREGONNo
5363A00000XPhysician AssistantPADA1230ALASKANo
6363A00000XPhysician AssistantPA65471CALIFORNIANo
7363A00000XPhysician Assistant10495MINNESOTAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
120047220AMEDICAIDOKLAHOMA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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