Healthcare Provider Details

I. General information

NPI: 1114836756
Provider Name (Legal Business Name): KATIE HELTON POTTS MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 SIERRA COLLEGE DR
GRASS VALLEY CA
95945-5768
US

IV. Provider business mailing address

180 SIERRA COLLEGE DR
GRASS VALLEY CA
95945-5768
US

V. Phone/Fax

Practice location:
  • Phone: 530-273-9541
  • Fax:
Mailing address:
  • Phone: 530-273-9541
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374700000X
TaxonomyTechnician
License NumberB8S6C3E2
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: