Individual
MRS. MANDY JO BUTLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
215 ELM ST, CLOVERPORT, KY 40111-1324
(270) 788-3000
Mailing address
215 ELM ST, CLOVERPORT, KY 40111-1324
(270) 788-3000
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
4083P
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000311345
BCBS
KY
01
—
50003764
PASSPORT
KY
05
—
78010758
—
KY
Enumeration date
07/11/2005
Last updated
04/30/2026
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