Healthcare Provider Details

I. General information

NPI: 1447807136
Provider Name (Legal Business Name): BUTLER FAMILY PRACTICE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2019
Last Update Date: 11/14/2024
Certification Date: 11/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6713 OLD JACKSONVILLE HWY STE 204
TYLER TX
75703-0753
US

IV. Provider business mailing address

6713 OLD JACKSONVILLE HWY STE 204
TYLER TX
75703-0753
US

V. Phone/Fax

Practice location:
  • Phone: 903-630-2197
  • Fax: 903-470-7372
Mailing address:
  • Phone: 903-630-2197
  • Fax: 903-470-7372

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. BEVERLY DIANN BUTLER
Title or Position: APRN, FNP-C
Credential: APRN, FNP-C
Phone: 936-675-0808