Provider Demographics
NPI:1952105413
Name:BUTTERFIELD, KHYRA J
Entity type:Individual
Prefix:
First Name:KHYRA
Middle Name:J
Last Name:BUTTERFIELD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5535 LYNVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21215-4314
Mailing Address - Country:US
Mailing Address - Phone:443-949-6117
Mailing Address - Fax:443-949-6117
Practice Address - Street 1:3 TALBOTT AVE STE 100
Practice Address - Street 2:
Practice Address - City:TIMONIUM
Practice Address - State:MD
Practice Address - Zip Code:21093-2329
Practice Address - Country:US
Practice Address - Phone:410-205-4928
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-03
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA0999390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program