Provider Demographics
NPI:1447659834
Name:BUTLER CHING, MARY SUSAN (PNP)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:SUSAN
Last Name:BUTLER CHING
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:SUSIE
Other - Middle Name:
Other - Last Name:BUTLER CHING
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PNP
Mailing Address - Street 1:1 CHILDRENS PL
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-1081
Mailing Address - Country:US
Mailing Address - Phone:314-454-6000
Mailing Address - Fax:
Practice Address - Street 1:1 CHILDRENS PL
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1081
Practice Address - Country:US
Practice Address - Phone:314-454-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-21
Last Update Date:2025-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2024049103363LP0200X
MO2024048278363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics