MEDICARE: MR. JASON R POTTS CRNP

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	363LF0000X	Family Nurse Practitioner	SP009273	PA

General Provider Information

NPI Number	:	1861559387
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JASON R POTTS CRNP

Provider Business Mailing Address
First Line	:	PO BOX 783311
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19178-3311
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1337 BLUE VALLEY DR
Second Line	:	STE 8
City	:	PEN ARGYL
State	:	PA
Zip	:	18072-1815
Country	:	US
Telephone Number	:	610-654-1230
Fax Number	:	610-654-1232

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

Provider Enumeration Date	:	01/03/2007
Last Update Date	:	12/21/2015

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