Provider Demographics
NPI:1720307416
Name:BUTLER, KRISTEN (MD)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:BUTLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6701 AIRPORT BLVD STE A208
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36608-3763
Mailing Address - Country:US
Mailing Address - Phone:251-266-3544
Mailing Address - Fax:251-266-3543
Practice Address - Street 1:6701 AIRPORT BLVD STE A208
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608-3763
Practice Address - Country:US
Practice Address - Phone:251-266-3544
Practice Address - Fax:251-266-3543
Is Sole Proprietor?:No
Enumeration Date:2010-05-20
Last Update Date:2019-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2016-00234208600000X
ALMD.374192086S0102X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1720307416Medicaid
SCNC2807Medicaid
NCNCT343AMedicare PIN