Provider Demographics
NPI:1801511589
Name:BUTLER, KRISTINA (FNP-C)
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:
Last Name:BUTLER
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1906 MYSTIC DR
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27712-4004
Mailing Address - Country:US
Mailing Address - Phone:814-969-8911
Mailing Address - Fax:
Practice Address - Street 1:131 MILLSTEAD DR
Practice Address - Street 2:
Practice Address - City:MEBANE
Practice Address - State:NC
Practice Address - Zip Code:27302-7165
Practice Address - Country:US
Practice Address - Phone:919-568-7440
Practice Address - Fax:919-568-7449
Is Sole Proprietor?:No
Enumeration Date:2022-10-05
Last Update Date:2024-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5019096363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily