Jacquelyn Faye Potts

Primary specialty

Nurse's AideTaxonomy code 376K00000X

License

111669 Issued in MO

Practice address

7813 E 130TH CT
Grandview, MO 64030-2729

Phone

(816) 966-0048

NPI assigned

Dec 26, 2007

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1198627200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1198627200000",
    "number": "1194909200",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7813 E 130TH CT",
            "city": "GRANDVIEW",
            "state": "MO",
            "postal_code": "640302729",
            "telephone_number": "816-966-0048"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7813 E 130TH CT",
            "city": "GRANDVIEW",
            "state": "MO",
            "postal_code": "640302729",
            "telephone_number": "816-966-0048"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POTTS",
        "first_name": "JACQUELYN",
        "middle_name": "FAYE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-12-26",
        "last_updated": "2007-12-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "376K00000X",
            "taxonomy_group": "",
            "desc": "Nurse's Aide",
            "state": "MO",
            "license": "111669",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sarah Elizabeth Papabathini, CPM
• Gary Park, PTA
• Gaitha Pennington, LPC
• Deborah S Perry, CPM
• Jennifer Yvonne Philipsheck, PHARM.D
• Preferred PT, LLC
• Premier Eyecare & Eyewear
• Principle First Assist, Inc.
• R B Shonkwiler LLC
• Marcus Ruben Ramos-Pearson, DMD

• All providers in Grandview, MO
• Nurse's Aide in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 26, 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.

Verify at the official NPI Registry.