Provider Demographics
NPI:1518992569
Name:BUTLER, MARI LYNNE (ARNP)
Entity type:Individual
Prefix:
First Name:MARI
Middle Name:LYNNE
Last Name:BUTLER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:MARI
Other - Middle Name:LYNNE
Other - Last Name:SHEETS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:395 HEMLOCK RD
Mailing Address - Street 2:
Mailing Address - City:BANNER ELK
Mailing Address - State:NC
Mailing Address - Zip Code:28604-8833
Mailing Address - Country:US
Mailing Address - Phone:336-899-4591
Mailing Address - Fax:
Practice Address - Street 1:540 WAUGH ST
Practice Address - Street 2:
Practice Address - City:JEFFERSON
Practice Address - State:NC
Practice Address - Zip Code:28640-9034
Practice Address - Country:US
Practice Address - Phone:336-899-4591
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2025-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1191002363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY7991OtherBCBS
FL305437300Medicaid