Healthcare Provider Details

I. General information

NPI: 1205756103
Provider Name (Legal Business Name): VELMA NICHOLE BUTLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 S JEFFERSON ST
PRINCETON KY
42445-2379
US

IV. Provider business mailing address

150 GUM ST
STURGIS KY
42459-7529
US

V. Phone/Fax

Practice location:
  • Phone: 270-365-9455
  • Fax:
Mailing address:
  • Phone: 270-871-1684
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number4061287
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: