Individual
JASON MICHAEL BUTLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
129 CENTER ST STE B, RICHLAND, MS 39218-4800
(769) 233-7141
Mailing address
314 CYPRESS CREEK RD, BRANDON, MS 39047-7989
(601) 421-1128
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
902078
MS
363LG0600X
Gerontology Nurse Practitioner
902078
MS
Other
Enumeration date
10/09/2017
Last updated
10/09/2017
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