Healthcare Provider Details

I. General information

NPI: 1538096813
Provider Name (Legal Business Name): TIMOTHY ABRAHAM BUTLER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2026
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 S NATIONAL AVE # PROF417
SPRINGFIELD MO
65897-0001
US

IV. Provider business mailing address

1301 OLD MILL CIR APT F
FAIR GROVE MO
65648-8601
US

V. Phone/Fax

Practice location:
  • Phone: 417-836-8220
  • Fax:
Mailing address:
  • Phone: 760-694-7496
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: