Provider Demographics
NPI:1801889506
Name:BUTLER, CAROLYN KAY
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:KAY
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 1:910 SYCAMORE AVE
Mailing Address - Street 2:SUITE 270
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92081-7832
Mailing Address - Country:US
Mailing Address - Phone:760-598-1700
Mailing Address - Fax:760-598-1196
Practice Address - Street 1:910 SYCAMORE AVE
Practice Address - Street 2:SUITE 270
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92081-7832
Practice Address - Country:US
Practice Address - Phone:760-598-1700
Practice Address - Fax:760-598-1196
Is Sole Proprietor?:No
Enumeration Date:2005-08-26
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA400963 NP8386363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARN8386Medicaid
CAWNP8386BMedicare PIN
CARN8386Medicaid