Provider Demographics
NPI:1629194691
Name:BUTLER, PAMELA A (APRN,BC, CPNP)
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:A
Last Name:BUTLER
Suffix:
Gender:F
Credentials:APRN,BC, CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 COUNTY ROAD 414
Mailing Address - Street 2:
Mailing Address - City:LORAINE
Mailing Address - State:TX
Mailing Address - Zip Code:79532-2120
Mailing Address - Country:US
Mailing Address - Phone:325-242-1530
Mailing Address - Fax:
Practice Address - Street 1:10 COUNTY ROAD 414
Practice Address - Street 2:
Practice Address - City:LORAINE
Practice Address - State:TX
Practice Address - Zip Code:79532-2120
Practice Address - Country:US
Practice Address - Phone:325-242-1530
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2013-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX231936363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics