Provider Demographics
NPI:1700451309
Name:BUTTS, AMY (RN, BSN)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:BUTTS
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:
Other - Last Name:REYES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:316 MISSION RD
Mailing Address - Street 2:
Mailing Address - City:KODIAK
Mailing Address - State:AK
Mailing Address - Zip Code:99615-7327
Mailing Address - Country:US
Mailing Address - Phone:907-486-3319
Mailing Address - Fax:
Practice Address - Street 1:316 MISSION RD
Practice Address - Street 2:
Practice Address - City:KODIAK
Practice Address - State:AK
Practice Address - Zip Code:99615-7327
Practice Address - Country:US
Practice Address - Phone:907-486-3319
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-25
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK121224163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health