Provider Demographics
NPI:1114341260
Name:BUTUK, REGINA (FNP)
Entity Type:Individual
Prefix:
First Name:REGINA
Middle Name:
Last Name:BUTUK
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 1:1500 UNIVERSITY DR E
Mailing Address - Street 2:SUITE 101
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77840-2600
Mailing Address - Country:US
Mailing Address - Phone:979-846-1100
Mailing Address - Fax:979-260-9390
Practice Address - Street 1:709 BARTON ST
Practice Address - Street 2:
Practice Address - City:HEARNE
Practice Address - State:TX
Practice Address - Zip Code:77859-3009
Practice Address - Country:US
Practice Address - Phone:979-279-3451
Practice Address - Fax:979-279-5163
Is Sole Proprietor?:No
Enumeration Date:2014-02-10
Last Update Date:2014-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX715676363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1558645333OtherNPI-HEARNE CHC
TX1821185299OtherAGENCY NPI (BVCAA, INC.)
TX67-1974OtherMEDICARE NUMBER FOR HEARNE COMMUNITY HEALTH CENTER
TX2872434-01OtherTPI FOR PRACTICE LOCATION WITH BVCAA, INC.