Provider Demographics
NPI:1649688987
Name:POTTS, JENNIFER (NP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:POTTS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4901 RALEIGH COMMON DR STE 100
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38128-2478
Mailing Address - Country:US
Mailing Address - Phone:901-572-1801
Mailing Address - Fax:901-730-0683
Practice Address - Street 1:4901 RALEIGH COMMON DR STE 100
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38128-2478
Practice Address - Country:US
Practice Address - Phone:901-572-1801
Practice Address - Fax:901-730-0683
Is Sole Proprietor?:No
Enumeration Date:2014-07-30
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN18965363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS902367OtherLICENSE