Healthcare Provider Details

I. General information

NPI: 1801711155
Provider Name (Legal Business Name): KAYLEE BUTCHER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2026
Last Update Date: 08/13/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

227 CROOKED CREEK ROAD
PEACH CREEK WV
25639
US

IV. Provider business mailing address

227 CROOKED CREEK ROAD PO BOX 175
PEACH CREEK WV
25639
US

V. Phone/Fax

Practice location:
  • Phone: 304-784-5171
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number116318
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: