Provider Demographics
NPI:1306047758
Name:POTEET, FLESHIA LYNN (CFA)
Entity type:Individual
Prefix:MS
First Name:FLESHIA
Middle Name:LYNN
Last Name:POTEET
Suffix:
Gender:F
Credentials:CFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 ANDREA ST STE 105
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42104-3382
Mailing Address - Country:US
Mailing Address - Phone:270-781-0177
Mailing Address - Fax:270-782-6023
Practice Address - Street 1:1300 ANDREA ST STE 105
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42104-3382
Practice Address - Country:US
Practice Address - Phone:270-781-0177
Practice Address - Fax:270-782-6023
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYSA153246ZS0410X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000489406OtherANTHEM PROVIDER NUMBER