Provider Demographics
NPI:1841686193
Name:BUTLER, KATHRYN VARGO (APRN BC FNP)
Entity type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:VARGO
Last Name:BUTLER
Suffix:
Gender:F
Credentials:APRN BC FNP
Other - Prefix:MS
Other - First Name:KATHRYN
Other - Middle Name:DOLORES
Other - Last Name:VARGO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:5965 PARKWAY NORTH BLVD
Mailing Address - Street 2:SUITE C
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30040
Mailing Address - Country:US
Mailing Address - Phone:770-886-5700
Mailing Address - Fax:770-886-0404
Practice Address - Street 1:5965 PARKWAY NORTH BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040
Practice Address - Country:US
Practice Address - Phone:770-886-5700
Practice Address - Fax:770-886-0404
Is Sole Proprietor?:No
Enumeration Date:2015-04-14
Last Update Date:2015-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN129146364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist