Provider Demographics
NPI:1194519595
Name:BUTCHER, KAYLA ELAINE
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:ELAINE
Last Name:BUTCHER
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:708 BADGER RD
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:MI
Mailing Address - Zip Code:48612-9461
Mailing Address - Country:US
Mailing Address - Phone:989-387-5335
Mailing Address - Fax:
Practice Address - Street 1:708 BADGER RD
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:MI
Practice Address - Zip Code:48612-9461
Practice Address - Country:US
Practice Address - Phone:989-387-5335
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-09
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704335822NSA2411E363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily