Healthcare Provider Details

I. General information

NPI: 1811242142
Provider Name (Legal Business Name): JENNY POTTER PSYD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2012
Last Update Date: 07/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 MCKOWN DR
NORMAN OK
73072-6678
US

IV. Provider business mailing address

1225 W MAIN ST STE 102
NORMAN OK
73069-6824
US

V. Phone/Fax

Practice location:
  • Phone: 405-321-3600
  • Fax: 405-801-2506
Mailing address:
  • Phone: 405-292-1000
  • Fax: 405-801-2506

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number1101
License Number StateOK

VIII. Authorized Official

Name: DR. JENNIFER R. POTTER
Title or Position: OWNER
Credential: PSYD
Phone: 405-292-1000