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 1:520 FULLERTON RD STE B
Mailing Address - Street 2:
Mailing Address - City:SWANSEA
Mailing Address - State:IL
Mailing Address - Zip Code:62226-2901
Mailing Address - Country:US
Mailing Address - Phone:618-277-0006
Mailing Address - Fax:618-257-0641
Practice Address - Street 1:520 FULLERTON RD STE B
Practice Address - Street 2:
Practice Address - City:SWANSEA
Practice Address - State:IL
Practice Address - Zip Code:62226-2901
Practice Address - Country:US
Practice Address - Phone:618-277-0006
Practice Address - Fax:618-257-0641
Is Sole Proprietor?:No
Enumeration Date:2021-03-23
Last Update Date:2025-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015016704363LP0808X
MO2021010405363LP0808X
IL209023411363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health