Healthcare Provider Details

I. General information

NPI: 1225572126
Provider Name (Legal Business Name): LINSEY PHIPPS BUTLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LINSEY E PHIPPS

II. Dates (important events)

Enumeration Date: 12/12/2016
Last Update Date: 06/22/2022
Certification Date: 06/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4511 SOUTHLAKE PKWY
HOOVER AL
35244-3238
US

IV. Provider business mailing address

PO BOX 757
FLORENCE AL
35631-0757
US

V. Phone/Fax

Practice location:
  • Phone: 205-985-4398
  • Fax:
Mailing address:
  • Phone: 256-764-9697
  • Fax: 256-764-9699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number1-109672
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: