Healthcare Provider Details

I. General information

NPI: 1275968489
Provider Name (Legal Business Name): AMY RENEE BUTLER FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2013
Last Update Date: 08/28/2025
Certification Date: 08/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

980 EXECUTIVE DR STE D
OSAGE BEACH MO
65065-3495
US

IV. Provider business mailing address

980 EXECUTIVE DR STE D
OSAGE BEACH MO
65065-3495
US

V. Phone/Fax

Practice location:
  • Phone: 573-746-5474
  • Fax: 573-746-5475
Mailing address:
  • Phone: 573-746-5474
  • Fax: 737-465-4755

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2013033428
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: