Provider Demographics
NPI:1639489446
Name:BUTTRAM, ANGELA HOPE (BSN,MSN,FNP-C)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:HOPE
Last Name:BUTTRAM
Suffix:
Gender:F
Credentials:BSN,MSN,FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3413 GOLDEN ROAD
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701
Mailing Address - Country:US
Mailing Address - Phone:903-592-5601
Mailing Address - Fax:903-595-3304
Practice Address - Street 1:3413 GOLDEN ROAD
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701
Practice Address - Country:US
Practice Address - Phone:903-592-5601
Practice Address - Fax:903-595-3304
Is Sole Proprietor?:No
Enumeration Date:2010-10-14
Last Update Date:2010-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF0910299363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily