Healthcare Provider Details

I. General information

NPI: 1548908015
Provider Name (Legal Business Name): ASHLEY ANN POTTER APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2022
Last Update Date: 05/24/2022
Certification Date: 05/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 NW EXPWY
OKLAHOMA CITY OK
73112-4999
US

IV. Provider business mailing address

4008 LAMAR DR
DEL CITY OK
73115-4444
US

V. Phone/Fax

Practice location:
  • Phone: 405-949-3011
  • Fax:
Mailing address:
  • Phone: 918-399-6339
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number126136
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: