Provider Demographics
NPI:1669447405
Name:KERN-BUTLER, PATRICIA (PA-C)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:
Last Name:KERN-BUTLER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2304 CENTURY CENTER BLVD
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75062-4906
Mailing Address - Country:US
Mailing Address - Phone:972-721-8109
Mailing Address - Fax:972-721-8999
Practice Address - Street 1:15800 SPECTRUM DR APT 1120
Practice Address - Street 2:
Practice Address - City:ADDISON
Practice Address - State:TX
Practice Address - Zip Code:75001-6368
Practice Address - Country:US
Practice Address - Phone:210-213-1796
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2014-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA00699363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX86N294OtherBCBS
TX81N509Medicare PIN
TX86N294OtherBCBS
TXS56972Medicare UPIN