Provider Demographics
NPI:1699044768
Name:BUTLER, KRISTINA RENEE (ACNP)
Entity Type:Individual
Prefix:MS
First Name:KRISTINA
Middle Name:RENEE
Last Name:BUTLER
Suffix:
Gender:F
Credentials:ACNP
Other - Prefix:
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Mailing Address - Street 1:PO BOX 1671
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21501-1671
Mailing Address - Country:US
Mailing Address - Phone:240-964-8342
Mailing Address - Fax:240-964-8337
Practice Address - Street 1:12502 WILLOWBROOK RD
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-6491
Practice Address - Country:US
Practice Address - Phone:240-964-8750
Practice Address - Fax:240-964-8699
Is Sole Proprietor?:No
Enumeration Date:2011-12-20
Last Update Date:2021-08-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDR158737363L00000X, 363LA2100X
WV72317363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner