Provider Demographics
NPI:1891354494
Name:BUTLER, BEVERLY DIANN (APRN, DNP, FNP-C)
Entity Type:Individual
Prefix:DR
First Name:BEVERLY
Middle Name:DIANN
Last Name:BUTLER
Suffix:
Gender:F
Credentials:APRN, DNP, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5604 OLD BULLARD RD STE 107
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75703-4359
Mailing Address - Country:US
Mailing Address - Phone:903-630-2197
Mailing Address - Fax:903-630-2198
Practice Address - Street 1:5604 OLD BULLARD RD STE 107
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703-4359
Practice Address - Country:US
Practice Address - Phone:903-630-2197
Practice Address - Fax:903-630-2198
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-07
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP142397363LP2300X, 363LF0000X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty