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NPI Code Detail

MEDICARE: COLTON SLADE POTTER NP-C

MEDICARE: COLTON SLADE POTTER NP-C
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
1363LF0000XFamily Nurse Practitioner215785AR

General Provider Information

NPI Number : 1487479325
Entity Type Code : Individual
Provider Name (Legal Business Name) : COLTON SLADE POTTER NP-C
Provider Business Mailing Address
First Line : 225 E WASHINGTON AVE
Second Line :
City : JONESBORO
State : AR
Zip : 72401-3111
Country : US
Telephone Number : 870-207-4100
Fax Number :
Provider Business Practice Location Address
First Line : 225 E WASHINGTON AVE
Second Line :
City : JONESBORO
State : AR
Zip : 72401-3111
Country : US
Telephone Number : 870-207-4100
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/16/2024
Last Update Date : 01/30/2026

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