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NPI Code Detail

MEDICARE: MS. ANITA BUTLER RD, LD

MEDICARE: MS. ANITA BUTLER RD, LD
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
1133NN1002XNutrition Education NutritionistR08939TX

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1710000878OTHERTXRAILROAD MEDICARE PROV NO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1063417038
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. ANITA BUTLER RD, LD
Provider Business Mailing Address
First Line : 150 RIVER NORTH BLVD
Second Line :
City : STEPHENVILLE
State : TX
Zip : 76401-1803
Country : US
Telephone Number : 254-968-6051
Fax Number : 254-968-4950
Provider Business Practice Location Address
First Line : 150 RIVER NORTH BLVD
Second Line :
City : STEPHENVILLE
State : TX
Zip : 76401-1803
Country : US
Telephone Number : 254-968-6051
Fax Number : 254-968-4950
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/16/2005
Last Update Date : 09/01/2009

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Directions to “ MS. ANITA BUTLER RD, LD” Practice Location

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