Active NPI
Patty Janelle Potts, DPH
- Pharmacist
- Maysville, OK
National Provider Identifier
1164417739
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 11129
- Practice address
- 500 Williams St
Jacks RX
Maysville, OK 73057-9547 - Phone
- (405) 867-4427
- Fax
- (405) 867-5267
- NPI assigned
- Sep 20, 2005
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 11129 | OK | Primary |
Addresses
Primary practice location
500 Williams St
Jacks RX
Maysville, OK 73057-9547
Mailing address
RR 3
Box 178
Pauls Valley, OK 73075-9803
Phone (405) 238-3525
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11129 | OK | MD | Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Jack Justice | Past | Accepting new patients | |
| Jack Justice | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1127174400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1164417739",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "RR 3",
"address_2": "BOX 178",
"city": "PAULS VALLEY",
"state": "OK",
"postal_code": "730759803",
"telephone_number": "405-238-3525"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "500 WILLIAMS ST",
"address_2": "JACKS RX",
"city": "MAYSVILLE",
"state": "OK",
"postal_code": "730579547",
"telephone_number": "405-867-4427",
"fax_number": "405-867-5267"
}
],
"practiceLocations": [],
"basic": {
"last_name": "POTTS",
"first_name": "PATTY",
"middle_name": "JANELLE",
"name_prefix": "Dr.",
"credential": "DPH",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-09-20",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "OK",
"license": "11129",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Maysville, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.