Provider Demographics
NPI:1346648342
Name:BUTLER, JACQUELYN NORAH (FNP-C)
Entity Type:Individual
Prefix:
First Name:JACQUELYN
Middle Name:NORAH
Last Name:BUTLER
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:JACQUELYN
Other - Middle Name:NORAH
Other - Last Name:CANTU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-C
Mailing Address - Street 1:8970 W TROPICANA AVE STE 6
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89147-8137
Mailing Address - Country:US
Mailing Address - Phone:702-473-5333
Mailing Address - Fax:
Practice Address - Street 1:8970 W TROPICANA AVE STE 6
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89147-8137
Practice Address - Country:US
Practice Address - Phone:702-473-5333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-08
Last Update Date:2023-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP127148363LF0000X
NMCNP-03551363LF0000X
NV853800363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily