Provider Demographics
NPI:1679914832
Name:BUTTS, KIMBERLEY D (APRN)
Entity Type:Individual
Prefix:
First Name:KIMBERLEY
Middle Name:D
Last Name:BUTTS
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 1:6578 BRANCH HILL GUINEA PIKE
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:45140-9163
Mailing Address - Country:US
Mailing Address - Phone:513-678-5626
Mailing Address - Fax:513-860-9059
Practice Address - Street 1:4870 WUNNENBERG WAY
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:OH
Practice Address - Zip Code:45069
Practice Address - Country:US
Practice Address - Phone:513-860-4600
Practice Address - Fax:513-860-9059
Is Sole Proprietor?:No
Enumeration Date:2013-07-16
Last Update Date:2018-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3008124363L00000X
OH15410-NP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHH344710Medicare PIN
KYH341030Medicare PIN