Provider Demographics
NPI:1730910621
Name:BUCHANAN, KAYLA MCKENZIE (RN, FNP-C)
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:MCKENZIE
Last Name:BUCHANAN
Suffix:
Gender:F
Credentials:RN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1621 W PEACE ST
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MS
Mailing Address - Zip Code:39046-9041
Mailing Address - Country:US
Mailing Address - Phone:601-391-2716
Mailing Address - Fax:
Practice Address - Street 1:1621 W PEACE ST
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MS
Practice Address - Zip Code:39046-9041
Practice Address - Country:US
Practice Address - Phone:601-391-2716
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-12
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS906870363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily