Healthcare Provider Details

I. General information

NPI: 1356994123
Provider Name (Legal Business Name): TONYA M BUTLER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2019
Last Update Date: 05/17/2026
Certification Date: 05/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

223 JERSEY ST
WESTFIELD IN
46074-9187
US

IV. Provider business mailing address

223 JERSEY ST
WESTFIELD IN
46074-9187
US

V. Phone/Fax

Practice location:
  • Phone: 317-207-6387
  • Fax: 463-464-3005
Mailing address:
  • Phone: 317-207-6387
  • Fax: 463-464-3005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number71009150A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: