Provider Demographics
NPI:1275524381
Name:BUTLER, CINDY SUE (NP)
Entity Type:Individual
Prefix:MRS
First Name:CINDY
Middle Name:SUE
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 1:2002 BROOKSIDE DR
Mailing Address - Street 2:SUITE102
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-4634
Mailing Address - Country:US
Mailing Address - Phone:423-245-6000
Mailing Address - Fax:423-245-6062
Practice Address - Street 1:2002 BROOKSIDE DR
Practice Address - Street 2:SUITE102
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-4634
Practice Address - Country:US
Practice Address - Phone:423-245-6000
Practice Address - Fax:423-245-6062
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN90068RN363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3706367Medicaid
TN4081210OtherBLUE CROSS BLUE SHIELD
TNTN0107OtherJOHN DEERE
VA005807K71Medicare ID - Type Unspecified
TN4081210OtherBLUE CROSS BLUE SHIELD
TN3706367Medicaid