Individual
JAYDEN A POTTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
804 S BROADWAY ST, POTEAU, OK 74953-3834
(918) 647-9629
Mailing address
804 S BROADWAY ST, POTEAU, OK 74953-3834
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
YUQ947032551
BLUECROSS BLUESHIELD
OK
Enumeration date
05/05/2021
Last updated
05/05/2021
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