Provider Demographics
NPI:1225500168
Name:BUTLER, DENISE (FNP-C)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:
Last Name:BUTLER
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 STONEBRIDGE LN STE 100
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-0316
Mailing Address - Country:US
Mailing Address - Phone:817-421-2905
Mailing Address - Fax:
Practice Address - Street 1:175 STONEBRIDGE LN STE 100
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-0316
Practice Address - Country:US
Practice Address - Phone:817-421-2905
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-17
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX137857363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner