Provider Demographics
NPI:1639845472
Name:BUTCHER, TIFFANY MICHELLE (APRN FNP-BC)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:MICHELLE
Last Name:BUTCHER
Suffix:
Gender:F
Credentials:APRN 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:PO BOX 542
Mailing Address - Street 2:
Mailing Address - City:VERDUNVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:25649-0542
Mailing Address - Country:US
Mailing Address - Phone:304-601-2491
Mailing Address - Fax:
Practice Address - Street 1:BOONE MEMORIAL HOSPITAL
Practice Address - Street 2:701 MADISON AVENUE
Practice Address - City:MADISON
Practice Address - State:WV
Practice Address - Zip Code:25130
Practice Address - Country:US
Practice Address - Phone:304-369-1230
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-20
Last Update Date:2021-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV110267363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily