Provider Demographics
NPI:1508347147
Name:POTTER, PAIGE (PA)
Entity Type:Individual
Prefix:
First Name:PAIGE
Middle Name:
Last Name:POTTER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5964 W PARKER RD STE 100
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-7788
Mailing Address - Country:US
Mailing Address - Phone:469-495-9122
Mailing Address - Fax:469-495-0722
Practice Address - Street 1:5964 W PARKER RD STE 100
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-7788
Practice Address - Country:US
Practice Address - Phone:469-495-9122
Practice Address - Fax:469-495-0722
Is Sole Proprietor?:No
Enumeration Date:2018-08-22
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA12079363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant