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1518960681

NPI Code Detail

MEDICARE: KELLY J. BUTLER MD

MEDICARE: KELLY J. BUTLER MD

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	2084P0800X	Psychiatry Physician	01053711A	IN
2	2084P0800X	Psychiatry Physician	34651	KY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	CG3623	OTHER	IN	RAILROAD MEDICARE GROUP
4	160780	OTHER	IN	MEDICARE GROUP
5	P00289124	OTHER	KY	MEDICARE RAILROAD
13	260047968	OTHER	IN	MEDICARE RAILROAD
17	6764	OTHER	KY	MEDICARE GROUP
20	CK2274	OTHER	KY	RAILROAD MEDICARE GROUP

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	50704000	OTHER		MAGELLAN MIS GROUP
3	000000056294	OTHER		ANTHEM GROUP
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	2444451000	OTHER	KY	PASSPORT GROUP
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
9	1063415297	OTHER		GROUP NPI #
10	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
11	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
12	000000239719	OTHER		ANTHEM
14	2709741000	OTHER	KY	PASSPORT ADVANTAGE
15	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
16	2709741000	OTHER	KY	PASSPORT
18	264003000	OTHER		MAGELLAN MIS #
19	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1518960681
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY J. BUTLER MD

Provider Business Mailing Address
First Line	:	10513 CHAMPIONSHIP CT
Second Line	:
City	:	PROSPECT
State	:	KY
Zip	:	40059-8581
Country	:	US
Telephone Number	:	502-439-1481
Fax Number	:

Provider Business Practice Location Address
First Line	:	101 CABARRUS AVE E
Second Line	:
City	:	CONCORD
State	:	NC
Zip	:	28025-3699
Country	:	US
Telephone Number	:	888-849-7379
Fax Number	:	855-857-7333

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

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	05/03/2023

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Directions to “ KELLY J. BUTLER MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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