Provider Demographics
NPI:1720566565
Name:POTTER, LAURIE ANN (NP-C)
Entity type:Individual
Prefix:
First Name:LAURIE
Middle Name:ANN
Last Name:POTTER
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:LAURIE
Other - Middle Name:ANN
Other - Last Name:ROBERTSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6350 W ANDREW JOHNSON HWY
Mailing Address - Street 2:
Mailing Address - City:TALBOTT
Mailing Address - State:TN
Mailing Address - Zip Code:37877-8605
Mailing Address - Country:US
Mailing Address - Phone:800-355-3565
Mailing Address - Fax:423-714-2355
Practice Address - Street 1:801 N WEISGARBER RD STE 200
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37909-2707
Practice Address - Country:US
Practice Address - Phone:655-845-7278
Practice Address - Fax:865-584-3364
Is Sole Proprietor?:No
Enumeration Date:2018-08-03
Last Update Date:2020-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN23315363LF0000X
TNRN140234163W00000X
TN23315363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse