Individual
BENJAMIN POTTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ACNPC-AG
Contact information
Practice address
1800 IRVING PL, SHREVEPORT, LA 71101-4608
(318) 425-4096
Mailing address
1800 IRVING PL, SHREVEPORT, LA 71101-4608
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
211844
LA
Other
Enumeration date
02/14/2020
Last updated
02/14/2020
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