| Butler Family Practice | |
|
5604 Old Bullard Rd Ste 107 Tyler TX 75703-4359 | |
| (903) 630-2197 | |
| (903) 630-2198 |
| Full Name | Butler Family Practice |
|---|---|
| Speciality | Clinic/Center |
| Location | 5604 Old Bullard Rd Ste 107, Tyler, Texas |
| Authorized Official Name and Position | Beverly Diann Butler (APRN, FNP-C) |
| Authorized Official Contact | 9366750808 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Butler Family Practice 5604 Old Bullard Rd Ste 107 Tyler TX 75703-4359 Ph: (903) 630-2197 | Butler Family Practice 5604 Old Bullard Rd Ste 107 Tyler TX 75703-4359 Ph: (903) 630-2197 |
| NPI Number | 1447807136 |
|---|---|
| Provider Enumeration Date | 08/19/2019 |
| Last Update Date | 09/27/2023 |
| Medicare PECOS PAC ID | 2264763804 |
|---|---|
| Medicare Enrollment ID | O20191011000602 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1447807136 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| 363LF0000X | Nurse Practitioner - Family | (* (Not Available)) | Secondary |
| Provider Name | Beverly Diann Butler |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1891354494 PECOS PAC ID: 4082945621 Enrollment ID: I20191011000668 |
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