Individual
JASON D. BUTLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
FNP
Contact information
Practice address
1 SOUTHTOWNE DR, POTOSI, MO 63664-5729
(735) 438-9355
Mailing address
1 SOUTHTOWNE DR, POTOSI, MO 63664-5729
(735) 438-9355
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
2003002337
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
424914307
—
MO
Enumeration date
03/22/2007
Last updated
04/03/2018
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