Provider Demographics
NPI:1013935998
Name:BUETTNER, NEIL W JR (CRNA)
Entity type:Individual
Prefix:
First Name:NEIL
Middle Name:W
Last Name:BUETTNER
Suffix:JR
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 506
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38088-0506
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1995 HIGHWAY 51 S
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:TN
Practice Address - Zip Code:38019-3635
Practice Address - Country:US
Practice Address - Phone:901-382-1200
Practice Address - Fax:901-382-8070
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS901876367500000X
TN9840367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4288522OtherBLUE SHIELD TN
TN2041149OtherUHC
TN3621368Medicaid
MS05629011OtherMEDICAID
TN2041149OtherUHC
TN3621368Medicaid
MS05629011OtherMEDICAID
TN3621368Medicare ID - Type UnspecifiedMEDICARE
TN3621368Medicaid