Kaitlin Buckner, P.A.

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

10495 Issued in MN

Practice address

6043 Hudson Rd Ste 220
Woodbury, MN 55125-1033

Phone

(651) 925-8200

Fax

(651) 925-8201

NPI assigned

Jun 23, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 7

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MN, TX, AK, OR, WA5 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 5

Specialty

Physician Assistant

Education

Other, 2004

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Bristol Bay Area Health CorporationGroup PAC ID 5890699920, 114 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Bristol Bay Dba Kanakanak Hospital Hospital, Dillingham, AK, CCN 021309

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Bristol Bay Area Health Corporation

  • Clinic/Center
  • Aleknagik North, AK
  • NPI 1235291246

  TX

  Medicare reassignment Care Compare group
• Kaiser Foundation Health Plan of the Northwest

  • General Practice Physician
  • Portland, OR
  • NPI 1184786527

  WA

  Medicare reassignment NPD
• Workit Health Mi PLLC

  • Addiction Medicine (Family Medicine) Physician
  • Anchorage, AK
  • NPI 1174142673
  Medicare reassignment NPD
• Southeast Alaska Regional Health Consortium

  • Clinic/Center
  • Thorne Bay, AK
  • NPI 1376758037

  TX

  Medicare reassignment
• Beaverton Rehab & Specialty Care, LLC

  • Skilled Nursing Facility
  • Beaverton, OR
  • NPI 1366469330
  NPD
• Bristol Bay Area Health Corporation

  • Clinic/Center
  • Koliganek, AK
  • NPI 1013079607
  NPD
• Bristol Bay Area Health Corporation

  • Clinic/Center
  • Ekwok, AK
  • NPI 1104988799
  NPD
• Bristol Bay Area Health Corporation

  • Clinic/Center
  • Pilot Point, AK
  • NPI 1174683825
  NPD
• Bristol Bay Area Health Corporation

  • Clinic/Center
  • Platinum, AK
  • NPI 1285796870
  NPD
• Bristol Bay Area Health Corporation

  • Clinic/Center
  • Levelock, AK
  • NPI 1366502767
  NPD
• Bristol Bay Area Health Corporation

  • Clinic/Center
  • South Naknek, AK
  • NPI 1417018193
  NPD
• Bristol Bay Area Health Corporation

  • Clinic/Center
  • Twin Hills, AK
  • NPI 1487716825
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Bristol Bay Area Health Corporation

  • Clinic/Center
  • Togiak, AK
  • NPI 1093877680

  Hospital

  Care Compare affiliation
• Bristol Bay Area Health Corporation

  • Critical Access Hospital
  • Dillingham, AK
  • NPI 1831270842
  Care Compare affiliation
• Bristol Bay Area Health Corporation

  • Critical Access Hospital
  • Dillingham, AK
  • NPI 1962688309
  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1151020800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1747526400000",
    "number": "1104852094",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "64 TOUCHSTONE",
            "city": "LAKE OSWEGO",
            "state": "OR",
            "postal_code": "970351909",
            "telephone_number": "702-994-4332"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6043 HUDSON RD STE 220",
            "city": "WOODBURY",
            "state": "MN",
            "postal_code": "551251033",
            "telephone_number": "651-925-8200",
            "fax_number": "651-925-8201"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "10180 SE Sunnyside Rd",
            "address_purpose": "LOCATION",
            "city": "Clackamas",
            "state": "OR",
            "postal_code": "970158970",
            "country_code": "US",
            "telephone_number": "800-813-2000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BUCKNER",
        "first_name": "KAITLIN",
        "credential": "P.A.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-23",
        "last_updated": "2025-05-18",
        "certification_date": "2025-05-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "UT",
            "license": "6669778-1206",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "AZ",
            "license": "3127",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OK",
            "license": "1414",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OR",
            "license": "PA223121",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "AK",
            "license": "PADA1230",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA65471",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MN",
            "license": "10495",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "20047220A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Clara Mae Brunk
• Luke Matthew Bruss, PT, DPT
• Ashley Marie Brusse, LICSW
• Tacara Bryant
• Melissa Marie Buchert
• Rodelio M Bucu, MD
• Gerald J Buda, CRNA
• Mark Budlong, DPT
• Angela Marie Buell, LICSW
• Susan Marie Buelow, RN CNS

• Physician Assistant in Woodbury, MN
• Providers in Woodbury, MN by specialty
• Physician Assistant in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 18, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.