Jesse R Potter, ATC, LAT

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

AT824 Issued in ME

Practice address

119 Gannett Dr
South Portland, ME 04106-6942

Phone

(207) 773-0040

NPI assigned

Dec 7, 2021

Last updated

Dec 7, 2021By the provider in NPPES

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

Other names 1

• Jesse R Littlefield Former name

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": "1638835200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1638835200000",
    "number": "1962160929",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15 COLD BEAR DR",
            "city": "WINDHAM",
            "state": "ME",
            "postal_code": "040623343"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "119 GANNETT DR",
            "city": "SOUTH PORTLAND",
            "state": "ME",
            "postal_code": "041066942",
            "telephone_number": "207-773-0040"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POTTER",
        "first_name": "JESSE",
        "middle_name": "R",
        "credential": "ATC, LAT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-12-07",
        "last_updated": "2021-12-07",
        "certification_date": "2021-12-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "ME",
            "license": "AT824",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JESSE",
            "last_name": "LITTLEFIELD",
            "middle_name": "R",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Julien Mario Powers-Candelmo, LCSW, CCS

• Athletic Trainer in South Portland, ME
• Providers in South Portland, ME by specialty
• Athletic Trainer in Maine

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 2021; 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.