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General NPI Number Information
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NPI Number | 1518960681
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Entity Type | Individual
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Provider Name | KELLY J. BUTLER MD
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Gender | Female
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Dates
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Enumeration Date | 05/23/2005
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Last Update Date | 05/03/2023
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Provider Practice Location Address
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Address Line | 101 CABARRUS AVE E
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City | CONCORD
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State | NC
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Zip | 28025-3699
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Country | US
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Telephone | 888-849-7379
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Fax | 855-857-7333
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Provider Business Mailing Address
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Address Line | 10513 CHAMPIONSHIP CT
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City | PROSPECT
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State | KY
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Zip | 40059-8581
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Country | US
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Telephone | 502-439-1481
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Fax |
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 01053711A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 34651
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License Number State | KY
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