Carol Jean Potter, NC60858445

Primary specialty

Nurse's AideTaxonomy code 376K00000X

License

NC60858445 Issued in WA

Practice address

5197 NW Lower River Rd
Vancouver, WA 98660-1013

Phone

(360) 205-1222

Fax

(360) 469-0112

NPI assigned

Feb 9, 2024

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

Practice roles

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.

• Lifeline Connections

  • Substance Abuse Rehabilitation Facility
  • Vancouver, WA
  • NPI 1689892473
  NPD (past)

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

{
    "created_epoch": "1707436800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1707436800000",
    "number": "1801650775",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7311 NE 142ND AVE",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986825020",
            "telephone_number": "360-991-9756"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5197 NW LOWER RIVER RD",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986601013",
            "telephone_number": "360-205-1222",
            "fax_number": "360-469-0112"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POTTER",
        "first_name": "CAROL",
        "middle_name": "JEAN",
        "credential": "NC60858445",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-02-09",
        "last_updated": "2024-02-09",
        "certification_date": "2024-02-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "376K00000X",
            "taxonomy_group": "",
            "desc": "Nurse's Aide",
            "state": "WA",
            "license": "NC60858445",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jennifer Claudia Poste, MD
• Julia Banchero Postlewaite, MD
• Anna Potoczny-Jones, DPT
• Leonid M Potryasov, MA60290799
• Allison Potter
• Matthew Potter
• Nicholle Potter
• Shimea Nicole Potter
• Emma Grace Potts
• Jacqueline Potts

• Nurse's Aide in Vancouver, WA
• Providers in Vancouver, WA by specialty
• Nurse's Aide in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 9, 2024; 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.