Provider Demographics
NPI:1215957758
Name:POTTER, RHONDA F (NP)
Entity type:Individual
Prefix:
First Name:RHONDA
Middle Name:F
Last Name:POTTER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1462 HIGHWAY 1 S
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38701-7140
Mailing Address - Country:US
Mailing Address - Phone:662-702-5121
Mailing Address - Fax:662-702-5123
Practice Address - Street 1:1462 HIGHWAY 1 S
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:MS
Practice Address - Zip Code:38701-7140
Practice Address - Country:US
Practice Address - Phone:662-702-5121
Practice Address - Fax:662-702-5123
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2019-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR857846363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner