Provider Demographics
NPI:1639461189
Name:BUTLER, PHYLLIS SUSAN (APN-C)
Entity type:Individual
Prefix:MRS
First Name:PHYLLIS
Middle Name:SUSAN
Last Name:BUTLER
Suffix:
Gender:F
Credentials:APN-C
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:860 HIGHWAY 62 E STE 10
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:AR
Mailing Address - Zip Code:72653-3200
Mailing Address - Country:US
Mailing Address - Phone:870-424-3181
Mailing Address - Fax:870-424-3089
Practice Address - Street 1:4313 S PLEASANT CROSSING BLVD
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758-1347
Practice Address - Country:US
Practice Address - Phone:479-947-4003
Practice Address - Fax:870-424-3089
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-03
Last Update Date:2021-02-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ARA03401 ANP363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health