Provider Demographics
NPI:1891951547
Name:BUTLER, JENE E (NP)
Entity Type:Individual
Prefix:
First Name:JENE
Middle Name:E
Last Name:BUTLER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:JENE
Other - Middle Name:E
Other - Last Name:GRAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:442 WHITE WING LN
Mailing Address - Street 2:
Mailing Address - City:MURPHY
Mailing Address - State:TX
Mailing Address - Zip Code:75094-4318
Mailing Address - Country:US
Mailing Address - Phone:972-837-0286
Mailing Address - Fax:
Practice Address - Street 1:442 WHITE WING LN
Practice Address - Street 2:
Practice Address - City:MURPHY
Practice Address - State:TX
Practice Address - Zip Code:75094-4318
Practice Address - Country:US
Practice Address - Phone:972-837-0286
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-01
Last Update Date:2017-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX697258363L00000X
TXAP117232363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX807N01OtherBCBS
TX204890203Medicaid
TXP00925353OtherRAILROAD
TX204890202Medicaid
TXTXB162318Medicare PIN
TXP00925353OtherRAILROAD
TXTXB162316Medicare PIN