KEIELLA BUTLER


Address: 3450 Highway 80 W, Jackson, MS 39209
Phone: 6013212400

KEIELLA BUTLER (NPI# 1821501388) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1821501388
Entity Type Individual
Full Name KEIELLA BUTLER
Credential PMHNP-BC
Practice Address 3450 Highway 80 W
Jackson
MS 39209
Mailing Address 3450 Highway 80 W
Jackson
MS 39209-7201
Practice Telephone 6013212400
Mailing Telephone 6013212400
Enumeration Date 2017-11-07
Last Update Date 2019-09-20
Gender Code F
Is Sole Proprietor N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 363LP0808X Nurse Practitioner
Specialization: Psych/Mental Health
902338 MS Physician Assistants & Advanced Practice Nursing Providers

Provider Secondary Practice Location

Address Telephone Number Fax Number
1059 Ridgewood Pl, Jackson, MS 392112018 6019573211 6019579753

Office Location

Street Address 3450 HIGHWAY 80 W
City JACKSON
State MS
Zip Code 39209

Providers in the same location

NPI Name Taxonomy Address Enumeration
1164468468 Jeffrey Asgar Ali Psychiatry & Neurology 3450 Highway 80 W, Jackson, MS 39209-7201 2006-06-22
1649878216 Donna Brown Counselor 3450 Highway 80 W, Jackson, MS 39209-7201 2020-10-15
1831797471 Tecola Bradley Counselor 3450 Highway 80 W, Jackson, MS 39209-7201 2020-10-15
1093313660 Detrick Johnson Counselor 3450 Highway 80 W, Jackson, MS 39209-7201 2020-10-15
1902404460 Brittany C Bloodsaw Counselor 3450 Highway 80 W, Jackson, MS 39209-7201 2020-10-15
1497353957 Lakeshia L Sutton Counselor 3450 Highway 80 W, Jackson, MS 39209-7201 2020-10-15
1134727605 Maya D Dezell Counselor 3450 Highway 80 W, Jackson, MS 39209-7201 2020-10-15
1275131740 Karla Banks Social Worker 3450 Highway 80 W, Jackson, MS 39209-7201 2020-10-15
1881292340 Lyser N Selmon Counselor 3450 Highway 80 W, Jackson, MS 39209-7201 2020-10-15
1568078566 Maricus Walker Counselor 3450 Highway 80 W, Jackson, MS 39209-7201 2020-09-16
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Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1235754995 Oak Street Health Physicians Group of Mississippi, LLC Family Medicine 911 Ellis Ave, Jackson, MS 39209 2020-06-09
1760003594 Phi Health, LLC Ambulance 582 Ramp Road, Suite C, Jackson, MS 39209 2020-05-04
1720468911 Genoa Healthcare, LLC Pharmacy 3450 Highway 80 W Rm 68, Jackson, MS 39209 2015-06-03
1013302082 Tiffany Griffin Nurse Practitioner 3450 Highway 80 West, Jackson, MS 39209 2015-04-06
1679961957 Cassetta Shontae Mcgee Emergency Medical Technician, Basic 5326 Queen Eleanor Ln, Jackson, MS 39209 2015-01-08
1124381280 Martin Solution In Home Supportive Care 917 West Ridge, Jackson, MS 39209 2012-06-22
1649533589 Adrinnie M Martin Contractor 917 Westridge, Jackson, MS 39209 2012-06-15
1831423862 Infinity House, Inc In Home Supportive Care 1042 Pecan Park Circle, Jackson, MS 39209 2009-09-23
1174751093 Linda M Vance Nurse Practitioner 1000 Metrocenter Ste 105, Jackson, MS 39209 2009-06-30
1770729998 Kim Hestle Speech-Language Pathologist 733 N. Flag Chapel Road, Jackson, MS 39209 2008-12-17
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Taxonomy Information

Taxonomy Code 363LP0808X
Grouping Physician Assistants & Advanced Practice Nursing Providers
Classification Nurse Practitioner
Specialization Psych/Mental Health

Taxonomy Definition

Definition to come...

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1912511981 Nurture Mental Health & Wellness Center LLC Nurse Practitioner 125 S King St Ste 2a, Jackson, WY 83001-8124 2020-09-07
1811511819 Aretha M. Northington Nurse Practitioner 1430 Wingfield Dr., Jackson, MS 39204-4448 2020-06-04
1760921225 A Beautiful Mind LLC Nurse Practitioner 1856 Smallwood St, Jackson, MS 39212-2521 2017-02-16
1013302082 Tiffany Griffin Nurse Practitioner 3450 Highway 80 West, Jackson, MS 39209 2015-04-06
1114311446 Lakeisha Crye Green Nurse Practitioner 5568 Tiki Ln, Jackson, MS 39212-3657 2015-03-25
1205176716 Robert White LLC Nurse Practitioner 2290 West County Line Rd, Suite 105, Jackson, NEW JERSEY 08527 2013-02-20
1699046235 Matrix Wellness Solutions Nurse Practitioner 384 Carriage House Dr Ste D, Suite D, Jackson, TN 38305-2268 2012-01-12
1063721314 Anna M Cook Nurse Practitioner 163 W Univeristy Parkway, Jackson, TN 38305 2010-10-05
1720245848 Carol Jeanne Dove Nurse Practitioner 4044 Briggs Ct, Jackson, MI 49201-9033 2008-05-16
1730203415 Sherry M Blackford Nurse Practitioner 238 Summar Drive, Jackson, TN 38301 2007-03-19
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Competitor

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City JACKSON
Zip Code 39209

Improve Information

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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