Individual
KATHLEEN M POTTS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CPNP
Contact information
Practice address
12303 DEPAUL DRIVE, BRIDGETON, MO 63044
(314) 344-6000
Mailing address
1836 LACKLAND HILL PKWY, ATTENTION: CREDENTIALING DEPARTMENT, SAINT LOUIS, MO 63146-3572
(314) 989-0300
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
051628
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
423901107
—
MO
Enumeration date
05/24/2006
Last updated
10/09/2017
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