Provider Demographics
NPI:1194799833
Name:BUTCHER, JANA SUE (ARNP)
Entity type:Individual
Prefix:
First Name:JANA
Middle Name:SUE
Last Name:BUTCHER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13505 FOX CREEK DR
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73131-1279
Mailing Address - Country:US
Mailing Address - Phone:405-478-5789
Mailing Address - Fax:405-271-6865
Practice Address - Street 1:1200 N PHILLIPS AVE
Practice Address - Street 2:SUITE 6100
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73104-4600
Practice Address - Country:US
Practice Address - Phone:405-271-6827
Practice Address - Fax:405-271-4418
Is Sole Proprietor?:No
Enumeration Date:2006-02-16
Last Update Date:2011-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0029827363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100173330AMedicare UPIN
OK247226002Medicare ID - Type Unspecified