Provider Demographics
NPI:1447807136
Name:BUTLER FAMILY PRACTICE PLLC
Entity Type:Organization
Organization Name:BUTLER FAMILY PRACTICE PLLC
Other - Org Name:BUTLER FAMILY PRACTICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:APRN, FNP-C
Authorized Official - Prefix:DR
Authorized Official - First Name:BEVERLY
Authorized Official - Middle Name:DIANN
Authorized Official - Last Name:BUTLER
Authorized Official - Suffix:
Authorized Official - Credentials:APRN, FNP-C
Authorized Official - Phone:936-675-0808
Mailing Address - Street 1:5604 OLD BULLARD RD STE 107
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75703-4359
Mailing Address - Country:US
Mailing Address - Phone:903-630-2197
Mailing Address - Fax:903-630-2198
Practice Address - Street 1:5604 OLD BULLARD RD STE 107
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703-4359
Practice Address - Country:US
Practice Address - Phone:903-630-2197
Practice Address - Fax:903-630-2198
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-19
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty