Provider Demographics
NPI:1881606895
Name:POTTER, KATHLEEN HUGHES (MN ARNP)
Entity type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:HUGHES
Last Name:POTTER
Suffix:
Gender:F
Credentials:MN ARNP
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:
Other - Last Name:HUGES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1151 WALKER RD
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19904-6600
Mailing Address - Country:US
Mailing Address - Phone:302-674-2380
Mailing Address - Fax:302-674-1299
Practice Address - Street 1:1151 WALKER RD
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19904-6600
Practice Address - Country:US
Practice Address - Phone:302-674-2380
Practice Address - Fax:302-674-1299
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2011-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30004049363LP0808X
DELE-0000180364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health