Provider Demographics
NPI:1437744877
Name:POTTER, MEGAN (LPN)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:POTTER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:POTTER
Other - Last Name:KERCHEE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPN
Mailing Address - Street 1:401 N 11TH ST
Mailing Address - Street 2:
Mailing Address - City:PONCA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:74601-4640
Mailing Address - Country:US
Mailing Address - Phone:918-237-3133
Mailing Address - Fax:
Practice Address - Street 1:401 N 11TH ST
Practice Address - Street 2:
Practice Address - City:PONCA CITY
Practice Address - State:OK
Practice Address - Zip Code:74601-4640
Practice Address - Country:US
Practice Address - Phone:918-237-3133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-08
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKL0060414164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse