Provider Demographics
NPI:1104861004
Name:BUTLER, PATRICIA B (NP)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:B
Last Name:BUTLER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 EXECUTIVE CIR
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31406-3345
Mailing Address - Country:US
Mailing Address - Phone:912-355-2400
Mailing Address - Fax:912-355-5324
Practice Address - Street 1:5 EXECUTIVE CIR
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-3345
Practice Address - Country:US
Practice Address - Phone:912-355-2400
Practice Address - Fax:912-355-5324
Is Sole Proprietor?:No
Enumeration Date:2006-06-17
Last Update Date:2008-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN093087363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000764849Medicaid
GA000764849BMedicaid
GA10059058OtherAMERIGROUP
GA000764849CMedicaid
GA000764849BMedicaid
GA500005746Medicare PIN
S74217Medicare UPIN