MEDICARE: REBECCA BUTLER CFNP

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	2004000989	MS

Other Identifiers

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

General Provider Information

NPI Number	:	1265445472
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBECCA BUTLER CFNP

Provider Business Mailing Address
First Line	:	PO BOX 353
Second Line	:
City	:	BELDEN
State	:	MS
Zip	:	38826
Country	:	US
Telephone Number	:	662-269-2230
Fax Number	:	662-269-2232

Provider Business Practice Location Address
First Line	:	2885 MCCULLOUGH BLVD
Second Line	:
City	:	BELDEN
State	:	MS
Zip	:	38826
Country	:	US
Telephone Number	:	662-269-2230
Fax Number	:	662-269-2232

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

Provider Enumeration Date	:	08/15/2006
Last Update Date	:	05/07/2014

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