Provider Demographics
NPI:1790355154
Name:POTTMEYER, CARLA (NP)
Entity type:Individual
Prefix:
First Name:CARLA
Middle Name:
Last Name:POTTMEYER
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 1:1085 JOE SKINNER RD
Mailing Address - Street 2:
Mailing Address - City:BELPRE
Mailing Address - State:OH
Mailing Address - Zip Code:45714-9488
Mailing Address - Country:US
Mailing Address - Phone:740-538-5405
Mailing Address - Fax:740-212-8308
Practice Address - Street 1:1085 JOE SKINNER RD
Practice Address - Street 2:
Practice Address - City:BELPRE
Practice Address - State:OH
Practice Address - Zip Code:45714-9488
Practice Address - Country:US
Practice Address - Phone:740-538-5405
Practice Address - Fax:740-212-8308
Is Sole Proprietor?:No
Enumeration Date:2021-06-29
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV111098363LP0808X
OH0029113363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health