Healthcare Provider Details

I. General information

NPI: 1417739137
Provider Name (Legal Business Name): CASEY POTEET
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2023
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1214 DEL MONTE AVE
FIRCREST WA
98466-6713
US

IV. Provider business mailing address

7171 DEVINE ST
BARTLETT TN
38133-3930
US

V. Phone/Fax

Practice location:
  • Phone: 901-828-2869
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number235624
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: