Provider Demographics
NPI:1922348192
Name:POTTER, KAREN (CRNP)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:POTTER
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 FITNESS WAY
Mailing Address - Street 2:SUITE 1200
Mailing Address - City:ATHENS
Mailing Address - State:AL
Mailing Address - Zip Code:35611-2492
Mailing Address - Country:US
Mailing Address - Phone:256-232-0636
Mailing Address - Fax:256-232-1058
Practice Address - Street 1:101 FITNESS WAY
Practice Address - Street 2:SUITE 1200
Practice Address - City:ATHENS
Practice Address - State:AL
Practice Address - Zip Code:35611-2492
Practice Address - Country:US
Practice Address - Phone:256-232-0636
Practice Address - Fax:256-232-1058
Is Sole Proprietor?:No
Enumeration Date:2013-02-25
Last Update Date:2015-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALI-102618364SF0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily Health