Active NPI
Jaclyn Suzanne Potts, CRNA
- Certified Registered Nurse Anesthetist
- Ardmore, OK
National Provider Identifier
1780968529
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Certified Registered Nurse Anesthetist
- License
- R0089907
- Practice address
- 2002 12TH Ave NW Ste C
Ardmore, OK 73401-1206 - Phone
- (405) 715-3610
- NPI assigned
- Sep 28, 2011
- 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 |
|---|---|---|---|---|
| Certified Registered Nurse Anesthetist | 367500000X | R0089907 | OK | Primary |
Addresses
Primary practice location
2002 12TH Ave NW Ste C
Ardmore, OK 73401-1206
Mailing address
PO Box 268988
Oklahoma City, OK 73126-8988
Phone (405) 715-3610
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 |
|---|---|---|---|
| R0089907 | OK | MD | Certified Registered Nurse Anesthetist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1317168000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1658361600000",
"number": "1780968529",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 268988",
"city": "OKLAHOMA CITY",
"state": "OK",
"postal_code": "731268988",
"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"
}
],
"practiceLocations": [],
"basic": {
"last_name": "POTTS",
"first_name": "JACLYN",
"middle_name": "SUZANNE",
"credential": "CRNA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-09-28",
"last_updated": "2022-07-21",
"status": "A"
},
"taxonomies": [
{
"code": "367500000X",
"taxonomy_group": "",
"desc": "Nurse Anesthetist, Certified Registered",
"state": "OK",
"license": "R0089907",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}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 Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.