Provider Demographics
NPI:1548249782
Name:BUTLER, JOELLEN HEGG (PSY NURSE PRACTITION)
Entity type:Individual
Prefix:
First Name:JOELLEN
Middle Name:HEGG
Last Name:BUTLER
Suffix:
Gender:F
Credentials:PSY NURSE PRACTITION
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9159 S GRANDVIEW DR
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85284-3141
Mailing Address - Country:US
Mailing Address - Phone:480-787-9384
Mailing Address - Fax:480-940-3922
Practice Address - Street 1:9159 S GRANDVIEW DR
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85284-3141
Practice Address - Country:US
Practice Address - Phone:480-787-9384
Practice Address - Fax:480-940-3922
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-16
Last Update Date:2021-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN083932363L00000X, 363LP0808X
AZAP6062363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZP22687Medicare UPIN