MALLORY LEIGH POTTEBAUM


Address: 505 S. 45th St, Omaha, NE 68198-0001
Phone: 4025595600

MALLORY LEIGH POTTEBAUM (NPI# 1487950945) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1487950945
Entity Type Individual
Full Name MALLORY LEIGH POTTEBAUM
Other Name MALLORY LEIGH JOHNSON
Credential PA-C
Practice Address 505 S. 45th St
Omaha
NE 68198-0001
Mailing Address 988102 Nebraska Medical Ctr
Omaha
NE 68198-8102
Practice Telephone 4025595600
Enumeration Date 2011-02-01
Last Update Date 2019-06-25
Gender Code F
Is Sole Proprietor N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 363A00000X Physician Assistant 1997 NE Physician Assistants & Advanced Practice Nursing Providers

Office Location

Street Address 505 S. 45TH ST
City OMAHA
State NE
Zip Code 68198-0001

Providers in the same location

NPI Name Taxonomy Address Enumeration
1255381158 James H Sorrell Psychiatry & Neurology 505 S. 45th St, Omaha, NE 68198-5575 2006-05-11
1437763109 Victoria Q Tran Nurse Practitioner 505 S. 45th St, Omaha, NE 68198-0001 2020-09-01
1548817240 Rachael A Sudtelgte Nurse Practitioner 505 S. 45th St, Omaha, NE 68198-0001 2019-08-19
1912565102 Patricia E Scott Nurse Practitioner 505 S. 45th St, Omaha, NE 68198-0001 2019-06-03
1114480845 Jasmin N Van Weelden Physician Assistant 505 S. 45th St, Omaha, NE 68198-0001 2019-04-10
1790176360 Brittany Mccoy Physician Assistant 505 S. 45th St, Omaha, NE 68198-0001 2015-02-18
1528466745 Lisa Keedy Nurse Practitioner 505 S. 45th St, Omaha, NE 68198-0001 2014-12-22
1043622764 Michael Baine Radiology 505 S. 45th St, Omaha, NE 68198-1045 2014-05-29
1275977654 Jessica Barbara Shank Surgery 505 S. 45th St, Omaha, NE 68198-0001 2013-04-29
1720321342 Elizabeth Bradford Bell Otolaryngology 505 S. 45th St, Omaha, NE 68198-0001 2013-04-02
Find all providers in the same location

Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1881259646 Grant Saltzgaber Family Medicine Unmc Dept. of Family Medicine, 983075 Nebraska Medical Center, Omaha, NE 68198 2019-05-07
1215590468 Elizabeth Farrell Counselor 42nd @ Dewey, Omaha, NE 68198 2019-04-15
1073033981 Daniel Ryan Mcdonald Anesthesiology 984150 Nebraska Medical Center, Omaha, NE 68198 2017-06-21
1194258764 Bryan Baker Student in an Organized Health Care Education/Training Program 986155 Nebraska Medical Ctr, Omaha, NE 68198 2017-04-10
1063862779 Evin Lackore Pediatrics Unmc Pediatrics Residency Program, 982185 Nebraska Medical Center, Omaha, NE 68198 2016-06-14
1710361233 Rahul Dhawan Student in an Organized Health Care Education/Training Program 982265 Nebraska Medical Center, Omaha, NE 68198 2015-07-14
1295129757 Brandon Mark Bennett Student in an Organized Health Care Education/Training Program 985640 Nebraska Medical Ctr, Omaha, NE 68198 2015-03-23
1083029151 Ashley Nelson Pediatrics 982185 Nebraska Medical Center, Omaha, NE 68198 2014-06-26
1013205590 Urmila Mukherjee Internal Medicine 989500 Nebraska Medical Ctr, Omaha, NE 68198 2011-07-18
1184943037 Melissa Teply Internal Medicine 989500 Nebraska Medical Center, Omaha, NE 68198 2010-05-18
Find all providers in zip 68198

Taxonomy Information

Taxonomy Code 363A00000X
Grouping Physician Assistants & Advanced Practice Nursing Providers
Classification Physician Assistant

Taxonomy Definition

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.

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1609475375 Patrick Donald Heavey Physician Assistant 4660 Pine St, Omaha, NE 68106-2520 2020-10-22
1780297440 Tayler Marie Llewellyn Physician Assistant 17241 Oak Dr, Omaha, NE 68130-2428 2020-08-24
1154933992 Alexandria Rae Mctaggart Physician Assistant 5024 S 130th St, Omaha, NE 68137-1820 2020-08-22
1124651443 Kathryn A Kesti Physician Assistant 4242 Farnam St Ste 500, Omaha, NE 68131-2850 2020-02-14
1760014757 Timothy Shew Physician Assistant 7500 Mercy Rd Ste 1300, Omaha, NE 68124-2319 2020-02-07
1083264303 Alicia K Clough Physician Assistant 15236 Westchester Dr, Omaha, NE 68154-2060 2019-09-18
1669935565 Taylor Elizabeth Hepp Physician Assistant 8005 Farnam Dr Ste 204, Omaha, NE 68114-3426 2019-04-09
1851895924 Mohammed Saeb Shakir Physician Assistant 7306 Ontario St, Omaha, NE 68124-3561 2018-03-22
1386162790 Anna Jean Sorrell Physician Assistant Emile St & S 42nd St, Omaha, NE 68198-4742 2017-09-06
1659804292 Kaitlyn Ann Boosalis Physician Assistant 4331 Mayberry St, Omaha, NE 68105-1711 2017-04-11
Find all providers in OMAHA

Competitor

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City OMAHA
Zip Code 68198

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Dataset Information

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.

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