Healthcare Provider Details

I. General information

NPI: 1134060015
Provider Name (Legal Business Name): KRISTY POTTS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2026
Last Update Date: 04/03/2026
Certification Date: 04/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1211 PORTER WAGONER BLVD
WEST PLAINS MO
65775-1826
US

IV. Provider business mailing address

1211 PORTER WAGONER BLVD
WEST PLAINS MO
65775-1826
US

V. Phone/Fax

Practice location:
  • Phone: 417-257-6762
  • Fax:
Mailing address:
  • Phone: 417-257-6762
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2025053551
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: