Individual
TIANA J. BUTLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
AGNP-C
Contact information
Practice address
615 S NEW BALLAS RD, SAINT LOUIS, MO 63141-8221
(314) 251-6000
Mailing address
PO BOX 1087, FLORISSANT, MO 63031-0087
(314) 358-9301
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
209030358
IL
363LA2200X
Adult Health Nurse Practitioner
Primary
AG08230039
MO
Other
Enumeration date
10/12/2023
Last updated
10/02/2024
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