Provider Demographics
NPI:1619597010
Name:POTTER, KELSEY LOUISE (FNP)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:LOUISE
Last Name:POTTER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:KELSEY
Other - Middle Name:LOUISE
Other - Last Name:HAMILTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:1735 27TH ST STE B06
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:OH
Mailing Address - Zip Code:45662-2681
Mailing Address - Country:US
Mailing Address - Phone:740-356-8008
Mailing Address - Fax:740-353-7900
Practice Address - Street 1:90 CIC BLVD
Practice Address - Street 2:
Practice Address - City:WEST UNION
Practice Address - State:OH
Practice Address - Zip Code:45693-8024
Practice Address - Country:US
Practice Address - Phone:937-544-8989
Practice Address - Fax:937-544-5659
Is Sole Proprietor?:No
Enumeration Date:2020-04-26
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.026530363L00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner