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NPI Code Detail

MEDICARE: REBECCA BUTLER PMHNP

MEDICARE: REBECCA BUTLER PMHNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LP0808XPsychiatric/Mental Health Nurse Practitioner2024024660MO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1558106997
Entity Type Code : Individual
Provider Name (Legal Business Name) : REBECCA BUTLER PMHNP
Provider Business Mailing Address
First Line : 1903 BRADY DR
Second Line :
City : JEFFERSON CITY
State : MO
Zip : 65101-5595
Country : US
Telephone Number : 573-230-3308
Fax Number :
Provider Business Practice Location Address
First Line : 1201 INTERNATIONAL DR
Second Line :
City : COLUMBIA
State : MO
Zip : 65202-1612
Country : US
Telephone Number : 572-615-2001
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/27/2024
Last Update Date : 02/15/2025

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