Healthcare Provider Details

I. General information

NPI: 1235002189
Provider Name (Legal Business Name): MARLY KATE BUTLER FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2025
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7378 YALE RD
BARTLETT TN
38133-3604
US

IV. Provider business mailing address

7378 YALE RD
BARTLETT TN
38133-3604
US

V. Phone/Fax

Practice location:
  • Phone: 907-378-0193
  • Fax:
Mailing address:
  • Phone: 901-378-0193
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number39967
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: