NPIMap

Organization Active NPI

Jaclyn S Potts Aprn-Crna PC

Doing business as South Central Anesthesia

  • Certified Registered Nurse Anesthetist
  • Ardmore, OK
National Provider Identifier
1013358647
Registry record updated Oct 31, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
R0089907 Issued in OK
Legal business name
JACLYN S POTTS APRN-CRNA PC
Doing business as
South Central Anesthesia
Practice address
2002 12TH Ave NW Ste C
Ardmore, OK 73401-1206
Phone
(405) 715-3610
Fax
(405) 715-3612
NPI assigned
Jul 11, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 31, 2018

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

Authorized official

Name
Jaclyn S Potts, CRNANPI 1780968529
Title
President
Phone
(405) 715-3610

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse AnesthetistGroup: 193400000X SINGLE SPECIALTY GROUP 367500000X R0089907 OK Primary

Addresses

Primary practice location

2002 12TH Ave NW Ste C
Ardmore, OK 73401-1206

Mailing address

P.O. Box 268988
Oklahoma City, OK 73126
Phone (405) 715-3610

Other names 1

  • South Central Anesthesia Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

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.

NPI Registry JSON

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

{
    "created_epoch": "1373500800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1540944000000",
    "number": "1013358647",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 268988",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "73126",
            "telephone_number": "405-715-3610",
            "fax_number": "405-715-3612"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2002 12TH AVE NW STE C",
            "city": "ARDMORE",
            "state": "OK",
            "postal_code": "734011206",
            "telephone_number": "405-715-3610",
            "fax_number": "405-715-3612"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACLYN S POTTS APRN-CRNA PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-07-11",
        "last_updated": "2018-10-31",
        "status": "A",
        "authorized_official_last_name": "POTTS",
        "authorized_official_first_name": "JACLYN",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "405-715-3610",
        "authorized_official_credential": "CRNA"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "OK",
            "license": "R0089907",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "South Central Anesthesia",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Ardmore, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.