Shimea Nicole Potter

Primary specialty

Case Manager/Care CoordinatorTaxonomy code 171M00000X

License

CG61265548 Issued in WA

Practice address

1601 E Fourth Plain Blvd BLDG 17
Vancouver, WA 98661-3717

Phone

(360) 397-8246

Fax

(360) 397-8250

NPI assigned

Jan 24, 2018

Sex

Female

Sole proprietor

No

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": "1516752000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1642723200000",
    "number": "1891293809",
    "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": "360-784-0912"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1601 E FOURTH PLAIN BLVD BLDG 17",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986613717",
            "telephone_number": "360-397-8246",
            "fax_number": "360-397-8250"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POTTER",
        "first_name": "SHIMEA",
        "middle_name": "NICOLE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-01-24",
        "last_updated": "2022-01-21",
        "certification_date": "2022-01-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": "WA",
            "license": "CG61265548",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Leonid M Potryasov, MA60290799
• Allison Potter
• Carol Jean Potter, NC60858445
• Matthew Potter
• Nicholle Potter
• Emma Grace Potts
• Jacqueline Potts
• Joseph Vincent Potts, RN
• Judith E Potts, MA
• Tawny Lynn Potts

• Case Manager/Care Coordinator in Vancouver, WA
• Providers in Vancouver, WA by specialty
• Case Manager/Care Coordinator in Washington

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

Verify at the official NPI Registry.