Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Kaitlin Buckner, PA

Individual provider Physician Assistant · NPI 1104852094

Kaitlin Buckner, PA is a Physician Assistant in Woodbury, Minnesota. Qualified in 2004, 22 years ago. Practices with Bristol Bay Area Health Corporation, a 113-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in Alaska, Arizona, California and Minnesota and 3 more.

Years since qualifying
22
Licensed in
AK, AZ, CA, MN, OK, OR
In the registry since
2006
Specialties on file
7
What do these letters mean?
PA — Physician Assistant
A licensed clinician who examines, diagnoses and treats under a physician's supervision.

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Practice location Address checks out

6043 Hudson Rd Ste 220
Woodbury, MN 55125-1033
Phone: (651) 925-8200
Fax: (651) 925-8201
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 10180 Se Sunnyside Rd, Clackamas, OR 97015-8970 — (800) 813-2000

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 10495 (MN)
Physician Assistant Taxonomy 363A00000X · Licence 6669778-1206 (UT)
Physician Assistant Taxonomy 363A00000X · Licence 3127 (AZ)
Physician Assistant Taxonomy 363A00000X · Licence 1414 (OK)
Physician Assistant Taxonomy 363A00000X · Licence PA223121 (OR)
Physician Assistant Taxonomy 363A00000X · Licence PADA1230 (AK)
Physician Assistant Taxonomy 363A00000X · Licence PA65471 (CA)

Record details

NPI number1104852094
Entity typeIndividual (Type 1)
GenderFemale
Credentials PA
Sole proprietorNo
NPI enumeratedJune 23, 2006
Last updated in NPPESMay 18, 2025
Certification dateMay 18, 2025
Mailing address64 Touchstone, Lake Oswego, OR 97035-1909

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2004 (22 years in practice)
Group practice Bristol Bay Area Health Corporation — 113 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations3 on file with Medicare

Other providers in Woodbury