Provider Demographics
NPI:1033898416
Name:BUTLER, SHELLIE ROSE (FNP)
Entity Type:Individual
Prefix:
First Name:SHELLIE
Middle Name:ROSE
Last Name:BUTLER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 MOUNTAIN LANE
Mailing Address - Street 2:
Mailing Address - City:NEW TAZEWELL
Mailing Address - State:TN
Mailing Address - Zip Code:37825
Mailing Address - Country:US
Mailing Address - Phone:865-382-0690
Mailing Address - Fax:
Practice Address - Street 1:2137 VOLUNTEER PARKWAY
Practice Address - Street 2:SUITE 5
Practice Address - City:BRISTOL
Practice Address - State:TN
Practice Address - Zip Code:37620
Practice Address - Country:US
Practice Address - Phone:423-722-5000
Practice Address - Fax:423-722-5130
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-13
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN34156363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily