MEDICARE: JASON MICHAEL 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	363LA2200X	Adult Health Nurse Practitioner	902078	MS
2	363LG0600X	Gerontology Nurse Practitioner	902078	MS

General Provider Information

NPI Number	:	1417467168
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JASON MICHAEL BUTLER NP

Provider Business Mailing Address
First Line	:	314 CYPRESS CREEK RD
Second Line	:
City	:	BRANDON
State	:	MS
Zip	:	39047-7989
Country	:	US
Telephone Number	:	601-421-1128
Fax Number	:

Provider Business Practice Location Address
First Line	:	129 CENTER ST STE B
Second Line	:
City	:	RICHLAND
State	:	MS
Zip	:	39218-4800
Country	:	US
Telephone Number	:	769-233-7141
Fax Number	:

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

Provider Enumeration Date	:	10/09/2017
Last Update Date	:	10/09/2017

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Directions to “ JASON MICHAEL BUTLER NP” Practice Location

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