Healthcare Provider Details

I. General information

NPI: 1578017554
Provider Name (Legal Business Name): BUTLER-ABSHIRE MEDICAL CLINIC, APMC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2016
Last Update Date: 08/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

926 FRANCES DR
HAYNESVILLE LA
71038-6100
US

IV. Provider business mailing address

926 FRANCES DR
HAYNESVILLE LA
71038-6100
US

V. Phone/Fax

Practice location:
  • Phone: 318-624-0554
  • Fax: 318-624-3782
Mailing address:
  • Phone: 318-624-0554
  • Fax: 318-624-3782

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP08913
License Number StateLA

VIII. Authorized Official

Name: SAMUEL K ABSHIRE
Title or Position: SEC/TREAS
Credential: M.D.
Phone: 318-624-0554