Provider Demographics
NPI:1588160634
Name:BUTLER, TERRI LASHUN
Entity type:Individual
Prefix:
First Name:TERRI
Middle Name:LASHUN
Last Name:BUTLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TERRI
Other - Middle Name:LASHUN
Other - Last Name:BUTLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 56042
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72215-6042
Mailing Address - Country:US
Mailing Address - Phone:501-744-9115
Mailing Address - Fax:
Practice Address - Street 1:15 AZALEA LOOP
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72032-8522
Practice Address - Country:US
Practice Address - Phone:501-744-9115
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-05
Last Update Date:2018-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist