Healthcare Provider Details

I. General information

NPI: 1316634587
Provider Name (Legal Business Name): LOGAN BUTLER PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/19/2023
Last Update Date: 05/11/2023
Certification Date: 04/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

603 W IRIS DR
NASHVILLE TN
37204-3120
US

IV. Provider business mailing address

123 SPARROW LN
DOVER TN
37058-5560
US

V. Phone/Fax

Practice location:
  • Phone: 615-538-5981
  • Fax:
Mailing address:
  • Phone: 615-613-2772
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number33838
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: