Healthcare Provider Details

I. General information

NPI: 1083623003
Provider Name (Legal Business Name): TADA KAREN BUTLER D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 HIGHWAY 463 N
TRUMANN AR
72472-3503
US

IV. Provider business mailing address

309 DUNWOODY DR
JONESBORO AR
72404-8889
US

V. Phone/Fax

Practice location:
  • Phone: 870-483-1075
  • Fax: 870-483-0244
Mailing address:
  • Phone: 870-483-1075
  • Fax: 870-483-0244

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberE3361
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: