Provider Demographics
NPI:1891175014
Name:BUCHANAN, KRISTEN S (MS)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:S
Last Name:BUCHANAN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 MONTE CARLO CT
Mailing Address - Street 2:
Mailing Address - City:SAINT AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32084-2587
Mailing Address - Country:US
Mailing Address - Phone:804-443-7026
Mailing Address - Fax:
Practice Address - Street 1:1851 GOLDEN EAGLE WAY
Practice Address - Street 2:STE. 43
Practice Address - City:FLEMING ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32003-4333
Practice Address - Country:US
Practice Address - Phone:904-374-1414
Practice Address - Fax:877-736-3470
Is Sole Proprietor?:No
Enumeration Date:2015-06-03
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL7092235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist