Provider Demographics
NPI:1891354494
Name:BUTLER, BEVERLY DIANN (APRN, DNP, FNP-C)
Entity type:Individual
Prefix:DR
First Name:BEVERLY
Middle Name:DIANN
Last Name:BUTLER
Suffix:
Gender:F
Credentials:APRN, DNP, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6713 OLD JACKSONVILLE HWY STE 204
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75703-0753
Mailing Address - Country:US
Mailing Address - Phone:903-630-2197
Mailing Address - Fax:903-470-7372
Practice Address - Street 1:6713 OLD JACKSONVILLE HWY STE 204
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703-0753
Practice Address - Country:US
Practice Address - Phone:903-630-2197
Practice Address - Fax:903-470-7372
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-07
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP142397363LP2300X, 363LF0000X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty