Healthcare Provider Details

I. General information

NPI: 1104748516
Provider Name (Legal Business Name): KAYLEE BUTLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

472 MAGNET SCHOOL RD
MALVERN AR
72104-3590
US

IV. Provider business mailing address

149 COUCHWOOD TER
HOT SPRINGS NATIONAL PARK AR
71901-8877
US

V. Phone/Fax

Practice location:
  • Phone: 501-332-5468
  • Fax:
Mailing address:
  • Phone: 501-303-0069
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberR103127
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: