Provider Demographics
NPI:1689815227
Name:BUECHTER, KENNAN JUDE (MD)
Entity Type:Individual
Prefix:DR
First Name:KENNAN
Middle Name:JUDE
Last Name:BUECHTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 W KINGSHIGHWAY STE 14
Mailing Address - Street 2:
Mailing Address - City:PARAGOULD
Mailing Address - State:AR
Mailing Address - Zip Code:72450-4197
Mailing Address - Country:US
Mailing Address - Phone:870-239-8591
Mailing Address - Fax:870-239-8137
Practice Address - Street 1:1000 W KINGSHIGHWAY STE 13
Practice Address - Street 2:
Practice Address - City:PARAGOULD
Practice Address - State:AR
Practice Address - Zip Code:72450-4197
Practice Address - Country:US
Practice Address - Phone:870-239-8107
Practice Address - Fax:870-239-8115
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-11
Last Update Date:2021-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-7408208600000X
LA627282NC0060X
ARE7408208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No282NC0060XHospitalsGeneral Acute Care HospitalCritical Access