Healthcare Provider Details

I. General information

NPI: 1942969761
Provider Name (Legal Business Name): RONALD BUTLER BA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/09/2021
Last Update Date: 12/09/2021
Certification Date: 12/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5966 SCOTTSVILLE RD STE 3
BOWLING GREEN KY
42104-7908
US

IV. Provider business mailing address

2623 CHEYENNE DR
BOWLING GREEN KY
42104-4205
US

V. Phone/Fax

Practice location:
  • Phone: 270-904-5104
  • Fax:
Mailing address:
  • Phone: 270-779-2987
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: