Healthcare Provider Details

I. General information

NPI: 1831564749
Provider Name (Legal Business Name): DONNA BUTLER FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2015
Last Update Date: 01/30/2024
Certification Date: 01/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

507 W MAIN ST
HOHENWALD TN
38462-1319
US

IV. Provider business mailing address

2375 RAILROAD BED RD
IRON CITY TN
38463-5741
US

V. Phone/Fax

Practice location:
  • Phone: 931-796-5943
  • Fax:
Mailing address:
  • Phone: 931-231-9692
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN0000020651
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: