Provider Demographics
NPI:1578270484
Name:BUTTKE, CANDI LYNN (APRN, PMHNP)
Entity Type:Individual
Prefix:MRS
First Name:CANDI
Middle Name:LYNN
Last Name:BUTTKE
Suffix:
Gender:F
Credentials:APRN, PMHNP
Other - Prefix:MRS
Other - First Name:CANDI
Other - Middle Name:LYNN
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:5509 FRONTIER DR
Mailing Address - Street 2:
Mailing Address - City:CRESTVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:32536-1819
Mailing Address - Country:US
Mailing Address - Phone:850-449-7973
Mailing Address - Fax:
Practice Address - Street 1:5509 FRONTIER DR
Practice Address - Street 2:
Practice Address - City:CRESTVIEW
Practice Address - State:FL
Practice Address - Zip Code:32536-1819
Practice Address - Country:US
Practice Address - Phone:850-449-7973
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-31
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9267827163W00000X
FLAPRN11025541363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse