Provider Demographics
NPI:1750695508
Name:BUTLER, KELLIE J (APRN)
Entity type:Individual
Prefix:
First Name:KELLIE
Middle Name:J
Last Name:BUTLER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17600 WINCHESTER RD
Mailing Address - Street 2:
Mailing Address - City:ASHVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43103-9428
Mailing Address - Country:US
Mailing Address - Phone:740-474-7071
Mailing Address - Fax:
Practice Address - Street 1:95 E MAIN ST
Practice Address - Street 2:
Practice Address - City:WEST JEFFERSON
Practice Address - State:OH
Practice Address - Zip Code:43162-1205
Practice Address - Country:US
Practice Address - Phone:614-879-7100
Practice Address - Fax:614-879-7151
Is Sole Proprietor?:No
Enumeration Date:2010-08-04
Last Update Date:2011-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP11631363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily