Individual
JACQUELYN ELIZABETH POTYNSKY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C, ATC
Contact information
Practice address
4208 MURDOCKSVILLE RD, WEST END, NC 27376-8871
(910) 235-5900
(910) 420-1606
Mailing address
100 MCKENZIE RD W, PINEHURST, NC 28374-9011
(703) 206-8282
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
0110005162
VA
363A00000X
Physician Assistant
Primary
NC0010-05796
NC
363AS0400X
Surgical Physician Assistant
NC0010-05796
NC
Other
Enumeration date
06/22/2015
Last updated
10/18/2023
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