Provider Demographics
NPI:1629654298
Name:BUCHANAN, KYRIA ANASTASIA (PMHNP)
Entity type:Individual
Prefix:MS
First Name:KYRIA
Middle Name:ANASTASIA
Last Name:BUCHANAN
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:KYRIA
Other - Middle Name:
Other - Last Name:KONIECZNY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:405 N LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:IL
Mailing Address - Zip Code:62269-1322
Mailing Address - Country:US
Mailing Address - Phone:813-838-2707
Mailing Address - Fax:
Practice Address - Street 1:3600 INTERSTATE 70 DR SE STE C
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-6583
Practice Address - Country:US
Practice Address - Phone:888-410-5230
Practice Address - Fax:573-271-5108
Is Sole Proprietor?:No
Enumeration Date:2021-03-23
Last Update Date:2024-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2021010405363LP0808X
IL209023411363LP0808X
MO2015016704363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health