MEDICARE: KATHY DIANE BUTLER NURSE PRACTITIONER

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	42136	TN

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	:	1376710624
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHY DIANE BUTLER NURSE PRACTITIONER

Provider Business Mailing Address
First Line	:	111 FRONT ST
Second Line	:
City	:	HENDERSON
State	:	TN
Zip	:	38340-2313
Country	:	US
Telephone Number	:	731-989-2829
Fax Number	:	731-520-0230

Provider Business Practice Location Address
First Line	:	7 LAPLACE DR
Second Line	:
City	:	JACKSON
State	:	TN
Zip	:	38305-3514
Country	:	US
Telephone Number	:	731-664-7949
Fax Number	:

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

Provider Enumeration Date	:	05/14/2008
Last Update Date	:	12/09/2025

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