Healthcare Provider Details

I. General information

NPI: 1154478162
Provider Name (Legal Business Name): ELIZABETH POTTER ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 01/27/2025
Certification Date: 01/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1412 KY-7
WEST LIBERTY KY
41472
US

IV. Provider business mailing address

842 HUTCHINSON RD
WEST LIBERTY KY
41472-2032
US

V. Phone/Fax

Practice location:
  • Phone: 606-743-1600
  • Fax: 606-743-2220
Mailing address:
  • Phone: 606-743-1600
  • Fax: 606-743-2220

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3003285
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number3003285
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: