Healthcare Provider Details

I. General information

NPI: 1467938936
Provider Name (Legal Business Name): JESSICA POTTER LOTT DNP, APRN, AGACNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JESSICA POTTER DNP

II. Dates (important events)

Enumeration Date: 07/17/2018
Last Update Date: 07/18/2023
Certification Date: 07/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 W 800 N STE 444
OREM UT
84057-6305
US

IV. Provider business mailing address

PO BOX 281490
ATLANTA GA
30384-1490
US

V. Phone/Fax

Practice location:
  • Phone: 801-743-4750
  • Fax: 801-743-7465
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number6907997-4405
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number6907997-4405
License Number StateUT
# 3
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number6907997-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: