Healthcare Provider Details

I. General information

NPI: 1578259347
Provider Name (Legal Business Name): FELICIA BUTLER MSN, APRN, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2023
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

602 S BROADWAY ST STE B
PORTLAND TN
37148-1607
US

IV. Provider business mailing address

602 S BROADWAY ST STE B
PORTLAND TN
37148-1607
US

V. Phone/Fax

Practice location:
  • Phone: 855-571-4500
  • Fax: 423-414-3022
Mailing address:
  • Phone: 855-571-4500
  • Fax: 423-414-3022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number33783
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: