Provider Demographics
NPI:1225535511
Name:POTTS, PEYTON (PA-C)
Entity Type:Individual
Prefix:
First Name:PEYTON
Middle Name:
Last Name:POTTS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:DEBORAH
Other - Middle Name:PEYTON
Other - Last Name:POTTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:23319 WILDERNESS CV
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78261-3030
Mailing Address - Country:US
Mailing Address - Phone:910-273-3382
Mailing Address - Fax:
Practice Address - Street 1:13909 NACOGDOCHES RD STE 111
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78217-1296
Practice Address - Country:US
Practice Address - Phone:210-655-0100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-12
Last Update Date:2020-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-07942363A00000X
TXPA13530363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant