MEDICARE: ALEXIS BUTLER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	F07241155	SC

General Provider Information

NPI Number	:	1013738327
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXIS BUTLER

Provider Business Mailing Address
First Line	:	420 E 2ND AVE
Second Line	:
City	:	ROME
State	:	GA
Zip	:	30161-3209
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4159 MARTHA BERRY HWY NW
Second Line	:
City	:	ROME
State	:	GA
Zip	:	30165-7705
Country	:	US
Telephone Number	:	706-232-8477
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/19/2024
Last Update Date	:	10/19/2024

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Directions to “ ALEXIS BUTLER ” Practice Location

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