Healthcare Provider Details

I. General information

NPI: 1013935998
Provider Name (Legal Business Name): NEIL W BUETTNER JR. CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 03/03/2025
Certification Date: 03/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1995 HIGHWAY 51 S
COVINGTON TN
38019-3635
US

IV. Provider business mailing address

PO BOX 506
CORDOVA TN
38088-0506
US

V. Phone/Fax

Practice location:
  • Phone: 901-382-1200
  • Fax: 901-382-8070
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number901876
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number9840
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: