Provider Demographics
NPI:1972978377
Name:BUTLER, JEREMY (NP-C)
Entity type:Individual
Prefix:
First Name:JEREMY
Middle Name:
Last Name:BUTLER
Suffix:
Gender:M
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2270 S RIDGEVIEW DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-8875
Mailing Address - Country:US
Mailing Address - Phone:928-329-4771
Mailing Address - Fax:928-329-4886
Practice Address - Street 1:2270 S RIDGEVIEW DR
Practice Address - Street 2:SUITE 300
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-8875
Practice Address - Country:US
Practice Address - Phone:928-329-4771
Practice Address - Fax:928-329-4886
Is Sole Proprietor?:No
Enumeration Date:2015-12-10
Last Update Date:2015-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP8337363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner