KENDRA RAE POTTER (NPI# 1255997086) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1255997086 |
| Entity Type | Individual |
| Full Name | KENDRA RAE POTTER |
| Credential | PA-C |
| Practice Address |
11200 Governor Manly Way Raleigh NC 27614-8599 |
| Mailing Address |
11200 Governor Manly Way Ste 309 Raleigh NC 27614-7375 |
| Practice Telephone | 9195629410 |
| Mailing Telephone | 9195629410 |
| Mailing Fax Number | 9195622948 |
| Enumeration Date | 2019-05-16 |
| Last Update Date | 2019-06-20 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | 0010-08835 | NC | Physician Assistants & Advanced Practice Nursing Providers |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 6602 Knightdale Blvd Ste 310, Knightdale, NC 275456526 | 9195629410 | 9195622948 |
| Street Address |
11200 GOVERNOR MANLY WAY |
| City | RALEIGH |
| State | NC |
| Zip Code | 27614-8599 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194708263 | Edgar Xavier Correa | Podiatrist | 11200 Governor Manly Way, Suite 309, Raleigh, NC 27614-8599 | 2005-11-22 |
| 1437769080 | Jerrell Parker | Physical Therapy Assistant | 11200 Governor Manly Way, Raleigh, NC 27614-8599 | 2020-08-07 |
| 1942719752 | Lisa Susanna Izzi | Specialist/Technologist | 11200 Governor Manly Way, Raleigh, NC 27614-8599 | 2017-09-25 |
| 1053843664 | Brooke Graves | Physician Assistant | 11200 Governor Manly Way, Raleigh, NC 27614-8599 | 2017-04-02 |
| 1356881528 | John Michael Ablan | Prevention Professional | 11200 Governor Manly Way, Raleigh, NC 27614-8599 | 2017-03-07 |
| 1174074769 | Kelsey Leigh Mancini | Specialist/Technologist | 11200 Governor Manly Way, Suite 309, Raleigh, NC 27614-8599 | 2016-10-18 |
| 1124579008 | Taylor Beavers | Specialist/Technologist | 11200 Governor Manly Way, Raleigh, NC 27614-8599 | 2016-10-17 |
| 1215483540 | Nicole Emilia Renfroe | Student in an Organized Health Care Education/Training Program | 11200 Governor Manly Way, Raleigh, NC 27614-8599 | 2016-08-28 |
| 1649725177 | Chelsea Christine Sorensen | Specialist/Technologist | 11200 Governor Manly Way, Raleigh, NC 27614-8599 | 2016-08-25 |
| 1942652839 | Chris Cardella | Specialist/Technologist | 11200 Governor Manly Way, Raleigh, NC 27614-8599 | 2016-07-05 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215419379 | Patrick Orion Finn | Family Medicine | 10010 Falls of The Neuse Rd, Suite 11, Raleigh, NC 27614 | 2018-09-05 |
| 1538652557 | Amn Medical Group Pllc | General Practice | 13200 Falls of Neuse Rd Ste 113, Raleigh, NC 27614 | 2018-06-13 |
| 1497201727 | Kelsey Scheerer | Student in an Organized Health Care Education/Training Program | 11200 Governor Way, Raleigh, NC 27614 | 2016-08-28 |
| 1538521463 | Liane Rudd | Speech-Language Pathologist | 4700 Norbury Place, Raleigh, NC 27614 | 2016-03-21 |
| 1891088068 | Michelle Lynn Thompson | Pharmacist | 10930 Raven Ridge Road, Raleigh, NC 27614 | 2011-05-22 |
| 1821396185 | Bettye Jo Johnson | Physical Medicine & Rehabilitation | 11200 Governor Manly Way, Suite 305, Orhopaedic Specialists of North Carolina, Pa, Raleigh, NC 27614 | 2011-03-09 |
| 1982900650 | Blake Jennings Lamm | Pharmacist | 14460 New Falls of Neuse Rd, Suite 165, Raleigh, NC 27614 | 2011-01-28 |
| 1013223023 | Lauren S Lawler | Pharmacist | 11201 Durant Road, Raleigh, NC 27614 | 2010-08-27 |
| 1588985378 | Kashif Mazhar | General Acute Care Hospital | 10010 Falls of Neuse Road, Suite #12, Raleigh, NC 27614 | 2010-06-16 |
| 1922240100 | Harris Teeter, LLC | Durable Medical Equipment & Medical Supplies | 14520 John Rex Blvd, Raleigh, NC 27614 | 2009-04-02 |
| Find all providers in zip 27614 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457961682 | Megan Kathleen Brown | Physician Assistant | 3024 New Bern Ave Ste 102, Raleigh, NC 27610-1247 | 2020-08-03 |
| 1124640651 | Kayla Marie Sincock | Physician Assistant | 12205 Harcourt Dr, Raleigh, NC 27613-5603 | 2020-05-06 |
| 1093340531 | Hannah Stanifer | Physician Assistant | 510 N Wilmington St Apt 227, Raleigh, NC 27604-8021 | 2020-03-05 |
| 1962035642 | Brianna Stolz | Physician Assistant | 3811 Ed Dr Ste 110, Raleigh, NC 27612-2393 | 2020-02-20 |
| 1316577737 | Jacey Elizabeth Byers | Physician Assistant | 700 Hawes Ct Apt C, Raleigh, NC 27608-1745 | 2020-01-24 |
| 1033756598 | Julie A Romeis | Physician Assistant | 1929 N Hills Dr Unit G, Raleigh, NC 27612-4022 | 2019-12-04 |
| 1346886769 | Pooja Parmar | Physician Assistant | 8804 Bluff Pointe Ct, Raleigh, NC 27615-4172 | 2019-11-20 |
| 1649829557 | Bryan Edwards | Physician Assistant | 4551 New Bern Ave Ste A100, Raleigh, NC 27610-1551 | 2019-09-04 |
| 1790343192 | Savanah Palen Mullen | Physician Assistant | 10208 Cerny St Ste 204, Raleigh, NC 27617-7885 | 2019-05-31 |
| 1356906184 | Andrew Paul Apicella | Physician Assistant | 3024 New Bern Ave Ste 302, Raleigh, NC 27610-1247 | 2019-05-07 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.