Provider Demographics
NPI:1427591247
Name:BUTLER, BETTY ROBERTSON (DNP, MSN, AGNP-C)
Entity Type:Individual
Prefix:
First Name:BETTY
Middle Name:ROBERTSON
Last Name:BUTLER
Suffix:
Gender:F
Credentials:DNP, MSN, AGNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5015 FLOYD RD, SUITE 710
Mailing Address - Street 2:
Mailing Address - City:MABLETON
Mailing Address - State:GA
Mailing Address - Zip Code:30126
Mailing Address - Country:US
Mailing Address - Phone:678-695-6989
Mailing Address - Fax:
Practice Address - Street 1:14141 SOUTHWEST FWY STE 500
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-3494
Practice Address - Country:US
Practice Address - Phone:281-356-0364
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-28
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP133436363LG0600X
GARN164564363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontologyGroup - Multi-Specialty
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA95005519OtherNP LICENSE AND FURNISHING NUMBER
CA603773OtherRN LICENSE