Provider Demographics
NPI:1508415811
Name:CARBUTT, AARON J (FNP-BC)
Entity Type:Individual
Prefix:MR
First Name:AARON
Middle Name:J
Last Name:CARBUTT
Suffix:
Gender:M
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1120 SHACKELFORD RD
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63031-4369
Mailing Address - Country:US
Mailing Address - Phone:314-830-5805
Mailing Address - Fax:
Practice Address - Street 1:5 SHADY MOSS CT
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63304-1214
Practice Address - Country:US
Practice Address - Phone:636-299-1327
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-09
Last Update Date:2019-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOP15252146L00000X
MO2019032650363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, Paramedic