Healthcare Provider Details

I. General information

NPI: 1346039062
Provider Name (Legal Business Name): KATELYN MCCLARAN BUTLER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2025
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6300 WILSHIRE BLVD STE 1110
LOS ANGELES CA
90048-5204
US

IV. Provider business mailing address

6300 WILSHIRE BLVD STE 1110
LOS ANGELES CA
90048-5204
US

V. Phone/Fax

Practice location:
  • Phone: 805-230-0527
  • Fax: 883-991-1856
Mailing address:
  • Phone:
  • Fax: 883-991-1856

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95029667
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number353770
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95029667
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: