Individual
KELLY J. BUTLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
101 CABARRUS AVE E, CONCORD, NC 28025-3699
(888) 849-7379
(855) 857-7333
Mailing address
10513 CHAMPIONSHIP CT, PROSPECT, KY 40059-8581
(502) 439-1481
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
01053711A
IN
2084P0800X
Psychiatry Physician
Primary
34651
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000056294
ANTHEM GROUP
—
01
—
000000239719
ANTHEM
—
01
—
100386460
MEDICAID GROUP
IN
01
—
1063415297
GROUP NPI #
—
01
—
160780
MEDICARE GROUP
IN
05
—
200319860A
—
IN
01
—
2444451000
PASSPORT GROUP
KY
01
—
260047968
MEDICARE RAILROAD
IN
01
—
264003000
MAGELLAN MIS #
—
01
—
2709741000
PASSPORT ADVANTAGE
KY
01
—
50704000
MAGELLAN MIS GROUP
—
05
—
64029762
—
KY
05
—
65927857
—
KY
01
—
6764
MEDICARE GROUP
KY
05
—
78903689
—
KY
05
—
82900176
—
KY
01
—
CG3623
RAILROAD MEDICARE GROUP
IN
01
—
CK2274
RAILROAD MEDICARE GROUP
KY
01
—
P00289124
MEDICARE RAILROAD
KY
Enumeration date
05/23/2005
Last updated
05/03/2023
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