Healthcare Provider Details

I. General information

NPI: 1609799717
Provider Name (Legal Business Name): POTTER WELLNESS & PRIMARY CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2026
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10982 N 1970 RD
ELK CITY OK
73644-6423
US

IV. Provider business mailing address

10982 N 1970 RD
ELK CITY OK
73644-6423
US

V. Phone/Fax

Practice location:
  • Phone: 580-821-0626
  • Fax:
Mailing address:
  • Phone: 580-821-0626
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MRS. SADIE MARIE POTTER
Title or Position: OWNER
Credential: APRN-CNP
Phone: 580-821-0626