MEDICARE: CHRISTINA ANNETTE POTTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	310400000X	Assisted Living Facility	209224	TX

General Provider Information

NPI Number	:	1427531516
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINA ANNETTE POTTER

Provider Business Mailing Address
First Line	:	6522 MALACHITE DR
Second Line	:
City	:	CORPUS CHRISTI
State	:	TX
Zip	:	78414-6079
Country	:	US
Telephone Number	:	361-765-5599
Fax Number	:

Provider Business Practice Location Address
First Line	:	3401 PREMIER DR
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75023-7087
Country	:	US
Telephone Number	:	469-649-8206
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/13/2018
Last Update Date	:	06/18/2026

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Directions to “ CHRISTINA ANNETTE POTTER ” Practice Location

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