Healthcare Provider Details

I. General information

NPI: 1043122773
Provider Name (Legal Business Name): CHELSEA GRACE POTTER MS, RD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2026
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3854 ALEX CT APT 5
COVINGTON KY
41017-8304
US

IV. Provider business mailing address

3854 ALEX CT APT 5
COVINGTON KY
41017-8304
US

V. Phone/Fax

Practice location:
  • Phone: 606-495-0633
  • Fax:
Mailing address:
  • Phone: 606-495-0633
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: