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General NPI Number Information
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NPI Number | 1164654000
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Entity Type | Individual
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Provider Name | MELANIE POTTER PA
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Gender | Female
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Dates
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Enumeration Date | 08/11/2009
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Last Update Date | 08/11/2009
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Provider Practice Location Address
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Address Line | 1201 W FRANK AVE
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City | LUFKIN
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State | TX
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Zip | 75904-3357
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Country | US
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Telephone | 936-639-7706
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Fax |
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Provider Business Mailing Address
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Address Line | 1717 MAIN ST STE 5200
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City | DALLAS
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State | TX
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Zip | 75201-4612
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Country | US
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Telephone | 214-712-2062
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Fax | 214-712-2487
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA01483
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License Number State | TX
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