Provider Demographics
NPI:1164476099
Name:JEHRIO-BUTLER, JENNIFER A (MD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:A
Last Name:JEHRIO-BUTLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1370 GATEWAY BLVD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37129-2589
Mailing Address - Country:US
Mailing Address - Phone:615-890-9008
Mailing Address - Fax:615-890-0193
Practice Address - Street 1:1370 GATEWAY BLVD
Practice Address - Street 2:SUITE 110
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37129-2589
Practice Address - Country:US
Practice Address - Phone:615-890-9008
Practice Address - Fax:615-890-0193
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2014-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2008-01044208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1515244Medicaid