Provider Demographics
NPI:1124015144
Name:BUTLER, LACINDA (WHNP)
Entity Type:Individual
Prefix:
First Name:LACINDA
Middle Name:
Last Name:BUTLER
Suffix:
Gender:F
Credentials:WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:244 COATSLAND DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38301-3948
Mailing Address - Country:US
Mailing Address - Phone:731-422-4642
Mailing Address - Fax:731-422-2277
Practice Address - Street 1:244 COATSLAND DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38301-3948
Practice Address - Country:US
Practice Address - Phone:731-422-4642
Practice Address - Fax:731-422-2277
Is Sole Proprietor?:No
Enumeration Date:2005-10-04
Last Update Date:2011-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN00000682525363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3908877Medicaid
TNP43798Medicare UPIN
TN3908877Medicaid