MEDICARE: RIVER CITY PSYCHIATRY, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1134906605
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RIVER CITY PSYCHIATRY, LLC

Provider Business Mailing Address
First Line	:	1085 JOE SKINNER RD
Second Line	:
City	:	BELPRE
State	:	OH
Zip	:	45714-9488
Country	:	US
Telephone Number	:	740-538-5405
Fax Number	:	740-212-8308

Provider Business Practice Location Address
First Line	:	1085 JOE SKINNER RD
Second Line	:
City	:	BELPRE
State	:	OH
Zip	:	45714-9488
Country	:	US
Telephone Number	:	740-538-5405
Fax Number	:	740-212-8308

Authorized Official
Title or Position	:	MEMBER
Name	:	MRS. CARLA Y POTTMEYER
Credential	:	APRN-CNP, PMHNP-BC
Telephone Number	:	740-525-4801

Provider Enumeration Date	:	09/11/2023
Last Update Date	:	06/18/2024

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