Active NPI
Jennifer Renee Potter, PSY.D.
- Clinical Psychologist
- Choctaw, OK
National Provider Identifier
1558517649
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 1101
- Practice address
- 14453 SE 29TH St
Suite D
Choctaw, OK 73020-6541 - Phone
- (405) 741-2844
- NPI assigned
- Aug 8, 2008
- 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 |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 1101 | OK | Primary |
Addresses
Primary practice location
14453 SE 29TH St
Suite D
Choctaw, OK 73020-6541
Mailing address
1025 Renita CT
Moore, OK 73160-8702
Phone (405) 837-5841
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 200226900A | Medicaid | OK |
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1101 | OK | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Poyner Psychological Services, Inc. | Past | Accepting new patients | |
| Poyner Mental Health Services | 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 and National Provider Directory roles.
-
- Mental Health Counselor
- Choctaw, OK
- NPI 1740845361
-
- Psychologist
- Choctaw, OK
- NPI 1457471765
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1218153600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1313020800000",
"number": "1558517649",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1025 RENITA CT",
"city": "MOORE",
"state": "OK",
"postal_code": "731608702",
"telephone_number": "405-837-5841"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "14453 SE 29TH ST",
"address_2": "SUITE D",
"city": "CHOCTAW",
"state": "OK",
"postal_code": "730206541",
"telephone_number": "405-741-2844"
}
],
"practiceLocations": [],
"basic": {
"last_name": "POTTER",
"first_name": "JENNIFER",
"middle_name": "RENEE",
"credential": "PSY.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-08-08",
"last_updated": "2011-08-11",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "OK",
"license": "1101",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "200226900A",
"state": "OK"
}
],
"endpoints": [],
"other_names": []
}Other providers in Choctaw, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.