Provider Demographics
NPI:1093196008
Name:BUTTS, KIMBERLY (MD)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:BUTTS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3135 W BROADWAY
Mailing Address - Street 2:
Mailing Address - City:COUNCIL BLUFFS
Mailing Address - State:IA
Mailing Address - Zip Code:51501-3359
Mailing Address - Country:US
Mailing Address - Phone:712-328-9100
Mailing Address - Fax:712-328-0095
Practice Address - Street 1:3135 W BROADWAY
Practice Address - Street 2:
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51501-3359
Practice Address - Country:US
Practice Address - Phone:712-328-9100
Practice Address - Fax:712-328-0095
Is Sole Proprietor?:No
Enumeration Date:2015-06-16
Last Update Date:2025-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE30519207Q00000X
IAMD-48114207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47068731749Medicaid
NE47068731741Medicaid
NE10026480100Medicaid
NE470553011-00Medicaid
IA1093196008Medicaid
NE47068731734Medicaid
NE47068731797Medicaid