Provider Demographics
NPI:1154478162
Name:POTTER, ELIZABETH (ARNP)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:POTTER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:842 HUTCHINSON RD
Mailing Address - Street 2:
Mailing Address - City:WEST LIBERTY
Mailing Address - State:KY
Mailing Address - Zip Code:41472-2032
Mailing Address - Country:US
Mailing Address - Phone:606-743-1600
Mailing Address - Fax:606-743-2220
Practice Address - Street 1:1412 KY-7
Practice Address - Street 2:
Practice Address - City:WEST LIBERTY
Practice Address - State:KY
Practice Address - Zip Code:41472
Practice Address - Country:US
Practice Address - Phone:606-743-1600
Practice Address - Fax:606-743-2220
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2021-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3285P363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY201287473001OtherCHAMPUS
KY000000338753OtherBLUE CROSS BLUE SHIELD
KY78004843Medicaid
KY201287473001OtherCHAMPUS
KYP22289Medicare UPIN
KY78004843Medicaid