Provider Demographics
NPI:1366803066
Name:POTTER, SHELBY (FNP)
Entity type:Individual
Prefix:
First Name:SHELBY
Middle Name:
Last Name:POTTER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:SHELBY
Other - Middle Name:
Other - Last Name:BURCHFIELD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:470 INDUSTRIAL LN
Mailing Address - Street 2:
Mailing Address - City:ONEIDA
Mailing Address - State:TN
Mailing Address - Zip Code:37841-6294
Mailing Address - Country:US
Mailing Address - Phone:423-286-4141
Mailing Address - Fax:423-286-4145
Practice Address - Street 1:25677 SCOTT HWY
Practice Address - Street 2:
Practice Address - City:WINFIELD
Practice Address - State:TN
Practice Address - Zip Code:37892-2293
Practice Address - Country:US
Practice Address - Phone:423-569-8064
Practice Address - Fax:423-569-2461
Is Sole Proprietor?:No
Enumeration Date:2016-03-09
Last Update Date:2016-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN20959363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily