MEDICARE: MR. JACOB ISRAEL 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	163WP0808X	Psychiatric/Mental Health Registered Nurse	AP126350	TX
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	AP126350	TX

General Provider Information

NPI Number	:	1598160491
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JACOB ISRAEL BUTLER NP

Provider Business Mailing Address
First Line	:	4849 N MESA ST STE 201
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79912-5919
Country	:	US
Telephone Number	:	915-351-6600
Fax Number	:	915-351-6601

Provider Business Practice Location Address
First Line	:	1900 DENVER AVE
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79902
Country	:	US
Telephone Number	:	915-544-3500
Fax Number	:	915-544-3503

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

Provider Enumeration Date	:	11/04/2014
Last Update Date	:	02/12/2026

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