Individual provider Active NPI

Layden Butler, PA

  • Physician Assistant
  • Nashville, TN
National Provider Identifier
1275268187
Registry record updated Dec 30, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
5669 Issued in TN
Practice address
802 Lincoya Bay Dr
Nashville, TN 37214-2682
Phone
(217) 273-2105
NPI assigned
Jul 24, 2022
Last updated
Dec 30, 2024By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 30, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 5669 TN Primary
Student in an Organized Health Care Education/Training Program 390200000X

Addresses

Primary practice location

802 Lincoya Bay Dr
Nashville, TN 37214-2682

Mailing address

1001 4TH Ave N Apt 240
Nashville, TN 37219-1143
Phone (217) 273-2105

Other practice location 1

718 E College St
Dickson, TN 37055-2032
Phone (615) 560-7016

Other practice location 2

2021 Western Ave
Mattoon, IL 61938-2854
Phone (217) 273-2105

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20231108003533 TN Practitioner - Physician Assistant 7719334960 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Fast Pace Medical Clinic PLLC CurrentSince Sep 30, 2023 Accepting new patients
Fast Pace Medical Clinic PLLC CurrentSince Sep 30, 2023 Accepting new patients

Locations

718 E College St
Dickson, TN 37055
Phone (615) 560-7016

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1658620800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1735516800000",
    "number": "1275268187",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1001 4TH AVE N APT 240",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372191143",
            "telephone_number": "217-273-2105"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "802 LINCOYA BAY DR",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372142682",
            "telephone_number": "217-273-2105"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "718 E College St",
            "address_purpose": "LOCATION",
            "city": "Dickson",
            "state": "TN",
            "postal_code": "370552032",
            "country_code": "US",
            "telephone_number": "615-560-7016",
            "fax_number": "615-560-7017",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2021 Western Ave",
            "address_purpose": "LOCATION",
            "city": "Mattoon",
            "state": "IL",
            "postal_code": "619382854",
            "country_code": "US",
            "telephone_number": "217-273-2105",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BUTLER",
        "first_name": "LAYDEN",
        "credential": "PA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-07-24",
        "last_updated": "2024-12-30",
        "certification_date": "2024-12-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TN",
            "license": "5669",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Nashville, TN

Sources for this page

Verify at the official NPI Registry.