Provider Demographics
NPI:1174094999
Name:POTTER, MONIKA RAE (PA)
Entity type:Individual
Prefix:
First Name:MONIKA
Middle Name:RAE
Last Name:POTTER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:MONIKA
Other - Middle Name:
Other - Last Name:MCCOWAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 936
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40743-0936
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:606-330-7825
Practice Address - Street 1:740 S LIMESTONE STE D201
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40536-9792
Practice Address - Country:US
Practice Address - Phone:859-323-0079
Practice Address - Fax:859-323-8173
Is Sole Proprietor?:No
Enumeration Date:2018-12-06
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPA2414363AM0700X, 363AS0400X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical