Youthful Essence Medical Center, PLLC

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

3285P Issued in KY

Legal business name

YOUTHFUL ESSENCE MEDICAL CENTER, PLLC

Practice address

1412 Ky-7
West Liberty, KY 41472

Phone

(606) 743-1600

Fax

(606) 743-2220

NPI assigned

Nov 6, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Elizabeth Potter, ARNPNPI 1154478162

Title

President

Phone

(606) 743-1600

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in KY

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Elizabeth Potter, ARNP

  • Family Nurse Practitioner
  • West Liberty, KY
  • NPI 1154478162
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1194307200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1640822400000",
    "number": "1760662852",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "842 HUTCHINSON RD",
            "city": "WEST LIBERTY",
            "state": "KY",
            "postal_code": "414722032",
            "telephone_number": "606-743-1600",
            "fax_number": "606-743-2220"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1412 KY-7",
            "city": "WEST LIBERTY",
            "state": "KY",
            "postal_code": "41472",
            "telephone_number": "606-743-1600",
            "fax_number": "606-743-2220"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1219 West Main Street",
            "address_purpose": "LOCATION",
            "city": "West Liberty",
            "state": "KY",
            "postal_code": "414721007",
            "country_code": "US",
            "telephone_number": "606-743-1600",
            "fax_number": "606-743-1924",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "YOUTHFUL ESSENCE MEDICAL CENTER, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-06",
        "last_updated": "2021-12-30",
        "certification_date": "2021-12-27",
        "status": "A",
        "authorized_official_last_name": "POTTER",
        "authorized_official_first_name": "ELIZABETH",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "606-743-1600",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "ARNP"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": "KY",
            "license": "3285P",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "78004843",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Matthew Kenneth Whitt, DC
• Monica Gibbs Whitt, MSPT
• Pamela Whitt
• Jessica Dawn Williams
• Joshua Williams

• Family Nurse Practitioner in West Liberty, KY
• Providers in West Liberty, KY by specialty
• Family Nurse Practitioner in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 30, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.