Healthcare Provider Details

I. General information

NPI: 1922348192
Provider Name (Legal Business Name): KAREN POTTER CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/25/2013
Last Update Date: 05/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 FITNESS WAY SUITE 1200
ATHENS AL
35611-2492
US

IV. Provider business mailing address

101 FITNESS WAY SUITE 1200
ATHENS AL
35611-2492
US

V. Phone/Fax

Practice location:
  • Phone: 256-232-0636
  • Fax: 256-232-1058
Mailing address:
  • Phone: 256-232-0636
  • Fax: 256-232-1058

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SF0001X
TaxonomyFamily Health Clinical Nurse Specialist
License NumberI-102618
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: