Healthcare Provider Details

I. General information

NPI: 1619799467
Provider Name (Legal Business Name): MICHAEL CORY BUTLER APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/31/2024
Last Update Date: 09/02/2025
Certification Date: 09/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1203 AMERICAN GREETING CARD RD
CORBIN KY
40701-4811
US

IV. Provider business mailing address

PO BOX 568
CORBIN KY
40702-0568
US

V. Phone/Fax

Practice location:
  • Phone: 606-528-7010
  • Fax: 606-536-7342
Mailing address:
  • Phone: 606-528-7010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1158017
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number4035525
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: