Provider Demographics
NPI:1366152639
Name:BUTLER, KAYLYN NICOLE
Entity type:Individual
Prefix:MRS
First Name:KAYLYN
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 1:149 FREEDOM CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:HARNED
Mailing Address - State:KY
Mailing Address - Zip Code:40144-5651
Mailing Address - Country:US
Mailing Address - Phone:270-230-5657
Mailing Address - Fax:
Practice Address - Street 1:149 FREEDOM CHURCH RD
Practice Address - Street 2:
Practice Address - City:HARNED
Practice Address - State:KY
Practice Address - Zip Code:40144-5651
Practice Address - Country:US
Practice Address - Phone:270-230-5657
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-28
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental TherapistGroup - Single Specialty