MEDICARE: NICHOLE MARIE POTTS APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2200X	Adult Health Nurse Practitioner	53-76064-012	KS

General Provider Information

NPI Number	:	1174957666
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICHOLE MARIE POTTS APRN

Provider Business Mailing Address
First Line	:	403 SYCAMORE ST
Second Line	:
City	:	VALLEY FALLS
State	:	KS
Zip	:	66088-1318
Country	:	US
Telephone Number	:	785-945-3263
Fax Number	:

Provider Business Practice Location Address
First Line	:	403 SYCAMORE ST
Second Line	:
City	:	VALLEY FALLS
State	:	KS
Zip	:	66088-1318
Country	:	US
Telephone Number	:	785-945-3263
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/03/2013
Last Update Date	:	09/03/2013

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