Provider Demographics
NPI:1386468569
Name:BUTCHER, TABITHA (FNP)
Entity type:Individual
Prefix:
First Name:TABITHA
Middle Name:
Last Name:BUTCHER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4959 EVANSVIEW RD
Mailing Address - Street 2:
Mailing Address - City:EVANS
Mailing Address - State:WV
Mailing Address - Zip Code:25241-8144
Mailing Address - Country:US
Mailing Address - Phone:304-373-4300
Mailing Address - Fax:
Practice Address - Street 1:146 PINNELL ST
Practice Address - Street 2:
Practice Address - City:RIPLEY
Practice Address - State:WV
Practice Address - Zip Code:25271-9101
Practice Address - Country:US
Practice Address - Phone:304-373-1537
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-13
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV109317363LW0102X, 363L00000X, 363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care