MEDICARE: KRISTA BUTLER

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	363LG0600X	Gerontology Nurse Practitioner	26NJ01452300	NJ

General Provider Information

NPI Number	:	1659071876
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTA BUTLER

Provider Business Mailing Address
First Line	:	131 GREENWOOD RD
Second Line	:
City	:	CHERRY HILL
State	:	NJ
Zip	:	08034-3804
Country	:	US
Telephone Number	:	856-220-6440
Fax Number	:

Provider Business Practice Location Address
First Line	:	401 YOUNG AVE STE 275B
Second Line	:
City	:	MOORESTOWN
State	:	NJ
Zip	:	08057-3130
Country	:	US
Telephone Number	:	856-291-8855
Fax Number	:

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

Provider Enumeration Date	:	03/07/2023
Last Update Date	:	06/09/2026

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Directions to “ KRISTA BUTLER ” Practice Location

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