Healthcare Provider Details

I. General information

NPI: 1215853056
Provider Name (Legal Business Name): RACHAEL L BUTLER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2026
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10502 N 110TH EAST AVE
OWASSO OK
74055-6655
US

IV. Provider business mailing address

1120 S KEELER AVE
BARTLESVILLE OK
74003-4753
US

V. Phone/Fax

Practice location:
  • Phone: 918-376-8000
  • Fax:
Mailing address:
  • Phone: 620-778-4807
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberL-322193
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: