Individual
JENNIE A POTTS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
13601 PRESTON RD, 1000W, DALLAS, TX 75240-4911
(972) 715-5000
Mailing address
PO BOX 650426, DALLAS, TX 75265-0426
(972) 715-5000
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
728287
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
219940801
—
TX
01
—
8934UA
BCBS
TX
Enumeration date
12/27/2010
Last updated
08/09/2011
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