Healthcare Provider Details

I. General information

NPI: 1861106874
Provider Name (Legal Business Name): CHARLOTTE MARIE BUTLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2023
Last Update Date: 01/13/2023
Certification Date: 01/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7407 PINEWOOD DR
MABELVALE AR
72103-4338
US

IV. Provider business mailing address

11701 INTERSTATE 30 STE 510
LITTLE ROCK AR
72209-7075
US

V. Phone/Fax

Practice location:
  • Phone: 501-765-4230
  • Fax:
Mailing address:
  • Phone: 501-747-1771
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: