Provider Demographics
NPI:1275826844
Name:BUTLER, MARY A (NP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:A
Last Name:BUTLER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:A
Other - Last Name:GREAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:755 N 11TH ST
Mailing Address - Street 2:STE P2280
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77702-1525
Mailing Address - Country:US
Mailing Address - Phone:409-892-4600
Mailing Address - Fax:409-892-4605
Practice Address - Street 1:755 N 11TH ST
Practice Address - Street 2:STE P2280
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77702-1525
Practice Address - Country:US
Practice Address - Phone:409-892-4600
Practice Address - Fax:409-892-4605
Is Sole Proprietor?:No
Enumeration Date:2011-05-16
Last Update Date:2011-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX694060363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner