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General NPI Number Information
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NPI Number | 1154604437
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Entity Type | Individual
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Provider Name | ERICA BUTLER PA-C
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Gender | Female
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Dates
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Enumeration Date | 09/23/2011
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Last Update Date | 03/15/2023
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Provider Practice Location Address
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Address Line | 9091 ELLERBE RD STE 200
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City | SHREVEPORT
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State | LA
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Zip | 71106-6737
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Country | US
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Telephone | 318-681-1630
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Fax | 318-681-1632
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Provider Business Mailing Address
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Address Line | 8383 MILLICENT WAY
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City | SHREVEPORT
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State | LA
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Zip | 71115-5207
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Country | US
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Telephone | 318-797-6661
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Fax | 318-795-8512
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 200487
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License Number State | LA
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