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Individual
SUSAN MARY POTTER
Active
Individual
SUSAN MARY POTTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
520140
TX
363L00000X
Nurse Practitioner
Primary
205349
OK
363L00000X
Nurse Practitioner
520140
TX
363LF0000X
Family Nurse Practitioner
AP106025
TX
363LG0600X
Gerontology Nurse Practitioner
AP106025
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8N9964
BLUE CROSS & BLUE SHIELD
TX
Enumeration date
10/18/2006
Last updated
06/02/2022
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