Provider Demographics
NPI:1023830379
Name:BUTLER, KINNETTE NICOLE
Entity type:Individual
Prefix:
First Name:KINNETTE
Middle Name:NICOLE
Last Name:BUTLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 HUMBLE AVE STE 171
Mailing Address - Street 2:120 WILLIS ATREET
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39401-6365
Mailing Address - Country:US
Mailing Address - Phone:601-620-4344
Mailing Address - Fax:
Practice Address - Street 1:301 HUMBLE AVE STE 171
Practice Address - Street 2:120 WILLIS ATREET
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39401-6365
Practice Address - Country:US
Practice Address - Phone:601-620-4344
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-28
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No172A00000XOther Service ProvidersDriver
No374U00000XNursing Service Related ProvidersHome Health Aide