Provider Demographics
NPI:1790314326
Name:BUCKHORN, SARA JESSICA (MSN, APRN, FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:SARA
Middle Name:JESSICA
Last Name:BUCKHORN
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:290 VILLAGE MEAD DR
Mailing Address - Street 2:
Mailing Address - City:BALLWIN
Mailing Address - State:MO
Mailing Address - Zip Code:63021-6129
Mailing Address - Country:US
Mailing Address - Phone:314-707-0643
Mailing Address - Fax:
Practice Address - Street 1:232 S WOODS MILL RD STE 330
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-3467
Practice Address - Country:US
Practice Address - Phone:314-205-6737
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-06
Last Update Date:2020-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2020008399363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily