Provider Demographics
NPI:1679824197
Name:BUTLER, HEATHER RAE (APRN)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:RAE
Last Name:BUTLER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1751 N ASPEN AVE
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012-1197
Mailing Address - Country:US
Mailing Address - Phone:918-794-6008
Mailing Address - Fax:918-516-3447
Practice Address - Street 1:7003 CHAD COLLEY BLVD
Practice Address - Street 2:
Practice Address - City:BARLING
Practice Address - State:AR
Practice Address - Zip Code:72923-3000
Practice Address - Country:US
Practice Address - Phone:479-431-3500
Practice Address - Fax:479-452-2098
Is Sole Proprietor?:No
Enumeration Date:2012-09-24
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0099836363LF0000X, 363LP2300X
ARA006199363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care