Provider Demographics
NPI:1578004305
Name:POTTER, MATTHEW G (APRN)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:G
Last Name:POTTER
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7617 UPPER JOHNS CREEK RD
Mailing Address - Street 2:
Mailing Address - City:PHELPS
Mailing Address - State:KY
Mailing Address - Zip Code:41553-8775
Mailing Address - Country:US
Mailing Address - Phone:606-835-9333
Mailing Address - Fax:606-835-9997
Practice Address - Street 1:7617 UPPER JOHNS CREEK RD
Practice Address - Street 2:
Practice Address - City:PHELPS
Practice Address - State:KY
Practice Address - Zip Code:41553-8775
Practice Address - Country:US
Practice Address - Phone:606-835-9333
Practice Address - Fax:606-835-9997
Is Sole Proprietor?:No
Enumeration Date:2017-03-13
Last Update Date:2025-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3011184363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner