Provider Demographics
NPI:1487755831
Name:POTTER, PATRICIA ANN (CNP)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:ANN
Last Name:POTTER
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 EOFF ST
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-3823
Mailing Address - Country:US
Mailing Address - Phone:304-234-8663
Mailing Address - Fax:304-234-1877
Practice Address - Street 1:107 PLAZA DR
Practice Address - Street 2:
Practice Address - City:SAINT CLAIRSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43950-8786
Practice Address - Country:US
Practice Address - Phone:740-695-2090
Practice Address - Fax:740-695-6379
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2013-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH05674363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2202388Medicaid
500010389OtherRAILROAD MEDICARE
WV9600162000Medicaid
500010389OtherRAILROAD MEDICARE
OH2202388Medicaid