MEDICARE: SHELITA Y BUTCHER

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	172V00000X	Community Health Worker

General Provider Information

NPI Number	:	1225380348
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHELITA Y BUTCHER

Provider Business Mailing Address
First Line	:	10516 BESSIE MAE CT
Second Line	:
City	:	CROWLEY
State	:	TX
Zip	:	76036-9551
Country	:	US
Telephone Number	:	817-622-8879
Fax Number	:	866-323-0948

Provider Business Practice Location Address
First Line	:	1813 SAN RAFAEL ST
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76134-4841
Country	:	US
Telephone Number	:	817-622-8879
Fax Number	:	866-323-0948

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

Provider Enumeration Date	:	10/12/2012
Last Update Date	:	06/01/2026

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Directions to “ SHELITA Y BUTCHER ” Practice Location

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