Provider Demographics
NPI:1437179553
Name:BUTLER, J DENNIS (CRNP)
Entity Type:Individual
Prefix:
First Name:J
Middle Name:DENNIS
Last Name:BUTLER
Suffix:
Gender:M
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1919 OXMOOR RD
Mailing Address - Street 2:STE 276
Mailing Address - City:HOMEWOOD
Mailing Address - State:AL
Mailing Address - Zip Code:35209-3502
Mailing Address - Country:US
Mailing Address - Phone:205-879-8294
Mailing Address - Fax:205-879-8259
Practice Address - Street 1:4704 CAHABA RIVER RD
Practice Address - Street 2:SUITE 101D
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35243-2344
Practice Address - Country:US
Practice Address - Phone:205-739-2266
Practice Address - Fax:205-739-2335
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2017-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-032598363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL500021680OtherRAILROAD MEDICARE
AL051551257Medicaid
AL051505975OtherBLUE CROSS
MS07501759OtherMISSISSIPPI MEDICAID
AL051551257Medicare ID - Type Unspecified