MEDICARE: MRS. TRICIA LEE BUTNER ARNP

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	28161	OK

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	:	1760487243
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TRICIA LEE BUTNER ARNP

Provider Business Mailing Address
First Line	:	7800 NW 85TH TER
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73132-3385
Country	:	US
Telephone Number	:	405-972-7239
Fax Number	:	405-753-1863

Provider Business Practice Location Address
First Line	:	2403 W WRANGLER BLVD STE A
Second Line	:
City	:	SEMINOLE
State	:	OK
Zip	:	74868
Country	:	US
Telephone Number	:	405-382-4939
Fax Number	:	405-242-5928

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

Provider Enumeration Date	:	06/20/2005
Last Update Date	:	06/25/2018

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