Healthcare Provider Details

I. General information

NPI: 1679824197
Provider Name (Legal Business Name): HEATHER RAE BUTLER APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2012
Last Update Date: 01/04/2024
Certification Date: 01/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7003 CHAD COLLEY BLVD
BARLING AR
72923-3000
US

IV. Provider business mailing address

1751 N ASPEN AVE
BROKEN ARROW OK
74012-1197
US

V. Phone/Fax

Practice location:
  • Phone: 479-431-3500
  • Fax: 479-452-2098
Mailing address:
  • Phone: 918-794-6008
  • Fax: 918-516-3447

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR0099836
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberR0099836
License Number StateOK
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberA006199
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: