Provider Demographics
NPI:1245259605
Name:BUTLER, JENNIFER W (ANP-BC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:W
Last Name:BUTLER
Suffix:
Gender:
Credentials:ANP-BC
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 207830
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75320-4670
Mailing Address - Country:US
Mailing Address - Phone:888-412-2649
Mailing Address - Fax:405-792-8910
Practice Address - Street 1:6473 KINGSTON PIKE
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37919-4832
Practice Address - Country:US
Practice Address - Phone:865-588-8831
Practice Address - Fax:865-588-8841
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN124123163W00000X
TN12553363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1512356Medicaid
TN1512356Medicaid