Provider Demographics
NPI:1659845782
Name:BUTLER, CARMEN RIDGEWAY (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:CARMEN
Middle Name:RIDGEWAY
Last Name:BUTLER
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1088 POND VIEW RD
Mailing Address - Street 2:
Mailing Address - City:MANNING
Mailing Address - State:SC
Mailing Address - Zip Code:29102-7816
Mailing Address - Country:US
Mailing Address - Phone:803-460-4640
Mailing Address - Fax:
Practice Address - Street 1:115 N SUMTER ST STE 305
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29150-4967
Practice Address - Country:US
Practice Address - Phone:803-305-1117
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-11
Last Update Date:2019-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC22202363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily