MEDICARE: MADISON RAE BUTLER NP

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	363L00000X	Nurse Practitioner	34633	TN

General Provider Information

NPI Number	:	1235919184
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MADISON RAE BUTLER NP

Provider Business Mailing Address
First Line	:	8516 GRACIE MAC LN
Second Line	:
City	:	OOLTEWAH
State	:	TN
Zip	:	37363-5791
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	140 W 14TH ST
Second Line	:
City	:	CHATTANOOGA
State	:	TN
Zip	:	37402-4403
Country	:	US
Telephone Number	:	423-682-8674
Fax Number	:

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

Provider Enumeration Date	:	09/28/2023
Last Update Date	:	09/28/2023

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