Provider Demographics
NPI:1902071475
Name:BUTLER, KIM A (PA-C)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:A
Last Name:BUTLER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2771 SILVER CREEK RD STE 101
Mailing Address - Street 2:
Mailing Address - City:BULLHEAD CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86442-7959
Mailing Address - Country:US
Mailing Address - Phone:928-704-0222
Mailing Address - Fax:928-704-2666
Practice Address - Street 1:2771 SILVER CREEK RD STE 101
Practice Address - Street 2:
Practice Address - City:BULLHEAD CITY
Practice Address - State:AZ
Practice Address - Zip Code:86442-7959
Practice Address - Country:US
Practice Address - Phone:928-704-0222
Practice Address - Fax:928-704-2666
Is Sole Proprietor?:No
Enumeration Date:2008-04-25
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZ1540363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical