Healthcare Provider Details

I. General information

NPI: 1720307416
Provider Name (Legal Business Name): KRISTEN BUTLER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2010
Last Update Date: 05/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6701 AIRPORT BLVD STE A208
MOBILE AL
36608-3763
US

IV. Provider business mailing address

6701 AIRPORT BLVD STE A208
MOBILE AL
36608-3763
US

V. Phone/Fax

Practice location:
  • Phone: 251-266-3544
  • Fax: 251-266-3543
Mailing address:
  • Phone: 251-266-3544
  • Fax: 251-266-3543

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number2016-00234
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License NumberMD.37419
License Number StateAL
# 3
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD.37419
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: