Provider Demographics
NPI:1194141127
Name:BUTLER, ERIN KENNEDY (PA-C)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:KENNEDY
Last Name:BUTLER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:KENNEDY
Other - Last Name:SCEIFRES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 936
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40743-0936
Mailing Address - Country:US
Mailing Address - Phone:859-629-7110
Mailing Address - Fax:859-543-1989
Practice Address - Street 1:3470 BLAZER PKWY STE 230
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-1887
Practice Address - Country:US
Practice Address - Phone:859-629-7110
Practice Address - Fax:859-543-1989
Is Sole Proprietor?:No
Enumeration Date:2014-03-14
Last Update Date:2019-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPA1917363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant