Healthcare Provider Details

I. General information

NPI: 1598219743
Provider Name (Legal Business Name): KARYN G BUTLER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2016
Last Update Date: 10/07/2024
Certification Date: 10/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2111 UNIVERSITY PARK DR STE 400
OKEMOS MI
48864-6907
US

IV. Provider business mailing address

2111 UNIVERSITY PARK DR STE 400
OKEMOS MI
48864-6907
US

V. Phone/Fax

Practice location:
  • Phone: 517-582-0180
  • Fax: 517-299-1029
Mailing address:
  • Phone: 517-258-0180
  • Fax: 517-299-1029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number4704199004
License Number StateMI

VIII. Authorized Official

Name: KARYN G BUTLER
Title or Position: OWNER
Credential: NP
Phone: 734-231-0933