Healthcare Provider Details

I. General information

NPI: 1801928189
Provider Name (Legal Business Name): DR. BUTLER & ASSOCIATES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2007
Last Update Date: 11/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2603 KENTUCKY AVE SUITE 303
PADUCAH KY
42003-3814
US

IV. Provider business mailing address

PO BOX 7626
PADUCAH KY
42002-7626
US

V. Phone/Fax

Practice location:
  • Phone: 270-443-2900
  • Fax: 270-443-7122
Mailing address:
  • Phone: 270-443-2900
  • Fax: 270-443-7122

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number29692
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA443
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number2980P
License Number StateKY

VIII. Authorized Official

Name: MRS. LORI W. BUTLER
Title or Position: OFFICE MANAGER
Credential:
Phone: 270-443-2900