Provider Demographics
NPI:1114995925
Name:POTEET-SCHWARTZ, KIM L (MD)
Entity Type:Individual
Prefix:DR
First Name:KIM
Middle Name:L
Last Name:POTEET-SCHWARTZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 N STATE ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216-4500
Mailing Address - Country:US
Mailing Address - Phone:601-815-1196
Mailing Address - Fax:601-984-5939
Practice Address - Street 1:800 MARSHALL ST # 203
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72202
Practice Address - Country:US
Practice Address - Phone:501-364-2933
Practice Address - Fax:501-364-2939
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-5737207L00000X
NM2003-0171207L00000X
MS25710207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR172298001Medicaid
NM57550069Medicaid
AR5H302Medicare PIN
NM341323006Medicare ID - Type UnspecifiedMEDICARE
NMH73405Medicare UPIN