Provider Demographics
NPI:1922566132
Name:BUTLER, SHELLEY T
Entity Type:Individual
Prefix:
First Name:SHELLEY
Middle Name:T
Last Name:BUTLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:911 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FLOYD
Mailing Address - State:VA
Mailing Address - Zip Code:24091-4183
Mailing Address - Country:US
Mailing Address - Phone:540-745-2031
Mailing Address - Fax:540-745-4028
Practice Address - Street 1:911 E MAIN ST
Practice Address - Street 2:
Practice Address - City:FLOYD
Practice Address - State:VA
Practice Address - Zip Code:24091-4183
Practice Address - Country:US
Practice Address - Phone:540-745-2031
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-06
Last Update Date:2021-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001238055163W00000X
VA0024177396363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0001238055OtherREGISTERED NURSE
VA0024177396OtherFAMILY NURSE PRACTITIONER