Basic Information
| Provider Information | |||||||||
| NPI: | 1033716634 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BUTLER | ||||||||
| FirstName: | SARAH | ||||||||
| MiddleName: | LYNNERAVEN PETTY | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2016 OSBOURNE CT | ||||||||
| Address2: | |||||||||
| City: | RALEIGH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 276044776 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9196181534 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5838 SIX FORKS RD STE 100 | ||||||||
| Address2: | |||||||||
| City: | RALEIGH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 276093893 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9197853400 | ||||||||
| FaxNumber: | 9197837778 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/06/2020 | ||||||||
| LastUpdateDate: | 11/13/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/13/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AS0400X | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical |
No ID Information.