Provider Demographics
NPI:1144607268
Name:POTTER, HILLARY-PAIGE GRAVES (PA)
Entity Type:Individual
Prefix:MRS
First Name:HILLARY-PAIGE
Middle Name:GRAVES
Last Name:POTTER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:HILLARY
Other - Middle Name:PAIGE
Other - Last Name:GRAVES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11350 MCCORMICK RD
Mailing Address - Street 2:EXECUTIVE PLAZA 1, SUITE 501
Mailing Address - City:HUNT VALLEY
Mailing Address - State:MD
Mailing Address - Zip Code:21031-1002
Mailing Address - Country:US
Mailing Address - Phone:301-528-2810
Mailing Address - Fax:301-528-2811
Practice Address - Street 1:17 MEDICAL PLZ
Practice Address - Street 2:
Practice Address - City:MOUNTAIN HOME
Practice Address - State:AR
Practice Address - Zip Code:72653-2918
Practice Address - Country:US
Practice Address - Phone:870-508-5900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-27
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPA-752363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical