Provider Demographics
NPI:1104363225
Name:BUSH BUTLER, ANASHA (FNP)
Entity Type:Individual
Prefix:
First Name:ANASHA
Middle Name:
Last Name:BUSH 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 1:324 N 14TH ST
Mailing Address - Street 2:
Mailing Address - City:NEDERLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77627-4039
Mailing Address - Country:US
Mailing Address - Phone:409-217-4057
Mailing Address - Fax:409-223-7994
Practice Address - Street 1:3600 GULFWAY DRIVE
Practice Address - Street 2:B
Practice Address - City:PORT ARTHUR
Practice Address - State:TX
Practice Address - Zip Code:77642
Practice Address - Country:US
Practice Address - Phone:409-217-4057
Practice Address - Fax:409-223-7994
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-26
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP 133078363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1104363225Medicaid