Healthcare Provider Details

I. General information

NPI: 1265445472
Provider Name (Legal Business Name): REBECCA BUTLER CFNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2006
Last Update Date: 05/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2885 MCCULLOUGH BLVD
BELDEN MS
38826
US

IV. Provider business mailing address

PO BOX 353
BELDEN MS
38826
US

V. Phone/Fax

Practice location:
  • Phone: 662-269-2230
  • Fax: 662-269-2232
Mailing address:
  • Phone: 662-269-2230
  • Fax: 662-269-2232

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2004000989
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: