Healthcare Provider Details

I. General information

NPI: 1619813466
Provider Name (Legal Business Name): BRANDON BUTLER HIS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2026
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1724 W KEARNEY ST STE 100
SPRINGFIELD MO
65803-1692
US

IV. Provider business mailing address

1724 W KEARNEY ST STE 100
SPRINGFIELD MO
65803-1692
US

V. Phone/Fax

Practice location:
  • Phone: 417-866-5505
  • Fax:
Mailing address:
  • Phone: 417-866-5505
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number2026014545
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: