Healthcare Provider Details

I. General information

NPI: 1073189205
Provider Name (Legal Business Name): JESSICA CARA BUTLER FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2021
Last Update Date: 11/04/2024
Certification Date: 11/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 OFFICE PARK DR
MINDEN LA
71055-3086
US

IV. Provider business mailing address

190 DOGWOOD TRL
MINDEN LA
71055-7364
US

V. Phone/Fax

Practice location:
  • Phone: 318-540-4202
  • Fax:
Mailing address:
  • Phone: 318-540-4202
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number220145
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: