Provider Demographics
NPI:1699452326
Name:BUTLER, KIERA JENELL
Entity type:Individual
Prefix:
First Name:KIERA
Middle Name:JENELL
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 1:3224 HILDAS COR SE
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30013-2239
Mailing Address - Country:US
Mailing Address - Phone:850-896-7088
Mailing Address - Fax:
Practice Address - Street 1:3224 HILDAS COR SE
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30013-2239
Practice Address - Country:US
Practice Address - Phone:850-896-7088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-04
Last Update Date:2023-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program