Healthcare Provider Details

I. General information

NPI: 1679379358
Provider Name (Legal Business Name): JEREMY BUTLER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2025
Last Update Date: 03/14/2025
Certification Date: 03/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2285 YELLOW FERN PATH
SPRING TX
77386-4885
US

IV. Provider business mailing address

2285 YELLOW FERN PATH
SPRING TX
77386-4885
US

V. Phone/Fax

Practice location:
  • Phone: 713-380-0579
  • Fax:
Mailing address:
  • Phone: 713-380-0579
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number1193043
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: