Healthcare Provider Details

I. General information

NPI: 1386468569
Provider Name (Legal Business Name): TABITHA BUTCHER FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2024
Last Update Date: 11/13/2024
Certification Date: 11/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

146 PINNELL ST
RIPLEY WV
25271-9101
US

IV. Provider business mailing address

4959 EVANSVIEW RD
EVANS WV
25241-8144
US

V. Phone/Fax

Practice location:
  • Phone: 304-373-1537
  • Fax:
Mailing address:
  • Phone: 304-373-4300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number109317
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number109317
License Number StateWV
# 3
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number109317
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: