Provider Demographics
NPI:1780398008
Name:BUTLER, LATISHA N (CASE MANAGEMENT)
Entity type:Individual
Prefix:
First Name:LATISHA
Middle Name:N
Last Name:BUTLER
Suffix:
Gender:F
Credentials:CASE MANAGEMENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 BERKLEY CT APT 7
Mailing Address - Street 2:
Mailing Address - City:RADCLIFF
Mailing Address - State:KY
Mailing Address - Zip Code:40160-2071
Mailing Address - Country:US
Mailing Address - Phone:270-982-7372
Mailing Address - Fax:270-982-7372
Practice Address - Street 1:900 N MULBERRY ST STE 200
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-2188
Practice Address - Country:US
Practice Address - Phone:346-314-8344
Practice Address - Fax:270-982-7372
Is Sole Proprietor?:No
Enumeration Date:2023-01-11
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator