Provider Demographics
NPI:1043327018
Name:BUCKLEN, KATHRYN A (MD)
Entity Type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:A
Last Name:BUCKLEN
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:1 CHILDRENS PL
Mailing Address - Street 2:NWT 8328 CB 8116
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-1002
Mailing Address - Country:US
Mailing Address - Phone:314-454-2076
Mailing Address - Fax:314-747-8953
Practice Address - Street 1:1 CHILDRENS PL
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1002
Practice Address - Country:US
Practice Address - Phone:314-454-2076
Practice Address - Fax:314-747-8953
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2018-01-24
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Provider Licenses
StateLicense IDTaxonomies
MO2011011348208000000X, 2080H0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080H0002XAllopathic & Osteopathic PhysiciansPediatricsHospice and Palliative Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics