Provider Demographics
NPI:1780461830
Name:POTTS, JENNIFER JO (RN)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:JO
Last Name:POTTS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 267
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN FURNACE
Mailing Address - State:OH
Mailing Address - Zip Code:45629-0267
Mailing Address - Country:US
Mailing Address - Phone:740-259-7000
Mailing Address - Fax:740-480-5200
Practice Address - Street 1:7595 GALLIA PIKE
Practice Address - Street 2:
Practice Address - City:FRANKLIN FURNACE
Practice Address - State:OH
Practice Address - Zip Code:45629-8988
Practice Address - Country:US
Practice Address - Phone:740-259-7000
Practice Address - Fax:740-480-5200
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-12
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH431950163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1962801548Medicaid