Healthcare Provider Details

I. General information

NPI: 1437065786
Provider Name (Legal Business Name): KIMBERLY NICOLE BUTLER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2026
Last Update Date: 08/19/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

419 S THREE NOTCH ST
TROY AL
36081-2541
US

IV. Provider business mailing address

25 COUNTY ROAD 227
SELMA AL
36703
US

V. Phone/Fax

Practice location:
  • Phone: 334-770-0419
  • Fax:
Mailing address:
  • Phone: 334-419-4068
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number3930
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: