Provider Demographics
NPI:1245445055
Name:BUTLER, DIANE B (PA)
Entity type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:B
Last Name:BUTLER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MS
Other - First Name:DIANE
Other - Middle Name:HEIDI
Other - Last Name:BELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:20938 FIELD MANOR LN
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77450-5876
Mailing Address - Country:US
Mailing Address - Phone:281-642-0440
Mailing Address - Fax:
Practice Address - Street 1:10919 LOUETTA RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070-1667
Practice Address - Country:US
Practice Address - Phone:281-642-0440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2007-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA05205363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant