Basic Information
| Provider Information | |||||||||
| NPI: | 1275524381 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BUTLER | ||||||||
| FirstName: | CINDY | ||||||||
| MiddleName: | SUE | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | N.P. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2002 BROOKSIDE DR | ||||||||
| Address2: | SUITE102 | ||||||||
| City: | KINGSPORT | ||||||||
| State: | TN | ||||||||
| PostalCode: | 376604634 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4232456000 | ||||||||
| FaxNumber: | 4232456062 | ||||||||
| Practice Location | |||||||||
| Address1: | 2002 BROOKSIDE DR | ||||||||
| Address2: | SUITE102 | ||||||||
| City: | KINGSPORT | ||||||||
| State: | TN | ||||||||
| PostalCode: | 376604634 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4232456000 | ||||||||
| FaxNumber: | 4232456062 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/31/2005 | ||||||||
| LastUpdateDate: | 01/28/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/28/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 90068RN | TN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 3706367 | 05 | TN | MEDICAID | 4081210 | 01 | TN | BLUE CROSS BLUE SHIELD | OTHER | TN0107 | 01 | TN | JOHN DEERE | OTHER |