Provider Demographics
NPI:1669906228
Name:BUTLER, ODETTE AMANDA E (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:ODETTE AMANDA
Middle Name:E
Last Name:BUTLER
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:ODETTE AMANDA
Other - Middle Name:
Other - Last Name:PRINCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PMHNP-BC
Mailing Address - Street 1:555 ANDOVER PARK W STE 200
Mailing Address - Street 2:
Mailing Address - City:TUKWILA
Mailing Address - State:WA
Mailing Address - Zip Code:98188-3379
Mailing Address - Country:US
Mailing Address - Phone:404-985-1300
Mailing Address - Fax:
Practice Address - Street 1:555 ANDOVER PARK W
Practice Address - Street 2:
Practice Address - City:TUKWILA
Practice Address - State:WA
Practice Address - Zip Code:98188-3379
Practice Address - Country:US
Practice Address - Phone:404-751-3700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-20
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP61023343363LP0808X
GARN255982163W00000X, 163WP0807X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0807XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Child & Adolescent
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse