Provider Demographics
NPI:1245756972
Name:BUCKNER, KAYLEE CLAIR (APRN)
Entity Type:Individual
Prefix:
First Name:KAYLEE
Middle Name:CLAIR
Last Name:BUCKNER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:KAYLEE
Other - Middle Name:CLAIR
Other - Last Name:LUTTRELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:1 CHILDRENS WAY # 653
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72202-3500
Mailing Address - Country:US
Mailing Address - Phone:501-364-1100
Mailing Address - Fax:501-364-4082
Practice Address - Street 1:1 CHILDRENS WAY # 518
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72202-3500
Practice Address - Country:US
Practice Address - Phone:501-364-6601
Practice Address - Fax:501-364-6626
Is Sole Proprietor?:No
Enumeration Date:2017-08-15
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA005302363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily