Provider Demographics
NPI:1477707800
Name:POTTER, ASHLEY MARIE (PA-C)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:MARIE
Last Name:POTTER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6161 N HWY 161
Mailing Address - Street 2:CREDENTIALING DEPARTMENT
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75038-2220
Mailing Address - Country:US
Mailing Address - Phone:972-953-2439
Mailing Address - Fax:972-870-4915
Practice Address - Street 1:1205 AVONDALE HASLET RD STE 100
Practice Address - Street 2:
Practice Address - City:HASLET
Practice Address - State:TX
Practice Address - Zip Code:76052
Practice Address - Country:US
Practice Address - Phone:817-766-4001
Practice Address - Fax:817-766-4008
Is Sole Proprietor?:No
Enumeration Date:2008-11-12
Last Update Date:2018-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA11630363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT7143350-1206OtherUTAH STATE LICENSE