Provider Demographics
NPI:1386209732
Name:BUTLER, KATELYN LEE
Entity type:Individual
Prefix:
First Name:KATELYN
Middle Name:LEE
Last Name:BUTLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 MACNIDER CB# 7593
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27599-7593
Mailing Address - Country:US
Mailing Address - Phone:919-966-6770
Mailing Address - Fax:919-966-8419
Practice Address - Street 1:PEDIATRICS EDUCATION OFFICE CB# 7593
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27599-6610
Practice Address - Country:US
Practice Address - Phone:919-966-6770
Practice Address - Fax:919-966-8419
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-01
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2023-00793208000000X
NC250640390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program