Provider Demographics
NPI:1508557109
Name:BUZZARD, KIRSTEN LYNN
Entity Type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:LYNN
Last Name:BUZZARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2287 E 3100 AVE
Mailing Address - Street 2:
Mailing Address - City:BEECHER CITY
Mailing Address - State:IL
Mailing Address - Zip Code:62414-4046
Mailing Address - Country:US
Mailing Address - Phone:217-343-7888
Mailing Address - Fax:
Practice Address - Street 1:800 E CARPENTER ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62769-1000
Practice Address - Country:US
Practice Address - Phone:217-544-6464
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-16
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant