Jonathan Park Buckwalter, FNP-C

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

AP10723 Issued in AZ

Practice address

3075 N Windsong Dr Ste a
Prescott Valley, AZ 86314-1208

Phone

(928) 350-8780

NPI assigned

Oct 20, 2017

Last updated

Jul 30, 2020By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in AZ

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 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Yavapai Primary Care

  • Family Medicine Physician
  • Prescott Valley, AZ
  • NPI 1346871076
  Medicare reassignment NPD

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

{
    "created_epoch": "1508457600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1596067200000",
    "number": "1427569110",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 26568",
            "city": "PRESCOTT VALLEY",
            "state": "AZ",
            "postal_code": "863126568",
            "telephone_number": "928-778-1251",
            "fax_number": "928-778-7834"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3075 N WINDSONG DR STE A",
            "city": "PRESCOTT VALLEY",
            "state": "AZ",
            "postal_code": "863141208",
            "telephone_number": "928-350-8780"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BUCKWALTER",
        "first_name": "JONATHAN",
        "middle_name": "PARK",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-10-20",
        "last_updated": "2020-07-30",
        "certification_date": "2020-07-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "AZ",
            "license": "AP10723",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "AZ",
            "license": "RN174745",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Courtney Anne Brimm, M.S., SLP
• Brio Arizona Home Health, LLC (The Pines Home Health)
• Stacie L Brown, LPC, CCTP
• Julia Ann Bruce
• Mariha D Bryant, LMT
• David Sidney Burgoyne II, M.D.
• Burning Rubber LLC
• Sean Burton, PHARMD
• Michael Anthony Butler
• Daryl Butricks, REGIONAL MANAGER

• Family Nurse Practitioner in Prescott Valley, AZ
• Providers in Prescott Valley, AZ by specialty
• Family Nurse Practitioner in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2020; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.