Provider Demographics
NPI:1912898966
Name:BUTLER, JERMEL MONIQUE
Entity type:Individual
Prefix:
First Name:JERMEL
Middle Name:MONIQUE
Last Name:BUTLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JERMEL
Other - Middle Name:MONIQUE
Other - Last Name:COLEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3401 FANNIN ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77004-3806
Mailing Address - Country:US
Mailing Address - Phone:346-308-0294
Mailing Address - Fax:
Practice Address - Street 1:3401 FANNIN ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77004-3806
Practice Address - Country:US
Practice Address - Phone:346-308-0294
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-09
Last Update Date:2025-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX35071840172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver