Provider Demographics
NPI:1689113268
Name:BUTLER, ASHLIE DARREL (PMHNP-DNP)
Entity Type:Individual
Prefix:MISS
First Name:ASHLIE
Middle Name:DARREL
Last Name:BUTLER
Suffix:
Gender:F
Credentials:PMHNP-DNP
Other - Prefix:DR
Other - First Name:ASHLIE
Other - Middle Name:DARREL
Other - Last Name:BUTLER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PMHNP-DNP
Mailing Address - Street 1:11648 INWOOD ST
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11436-1348
Mailing Address - Country:US
Mailing Address - Phone:301-728-7621
Mailing Address - Fax:
Practice Address - Street 1:116-48 INWOOD STREET
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11436
Practice Address - Country:US
Practice Address - Phone:301-728-7621
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-16
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY40280901363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health