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NPI Code Detail

MEDICARE: JAIDENYCE POTTER

MEDICARE: JAIDENYCE POTTER
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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1316897523
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAIDENYCE POTTER
Provider Business Mailing Address
First Line : 550 CONGRESSIONAL BLVD STE 115
Second Line :
City : CARMEL
State : IN
Zip : 46032-5644
Country : US
Telephone Number : 317-249-2242
Fax Number :
Provider Business Practice Location Address
First Line : 3777 HALEY DR
Second Line :
City : NEWBURGH
State : IN
Zip : 47630-2608
Country : US
Telephone Number : 812-490-0904
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/29/2026
Last Update Date : 01/29/2026

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Directions to “ JAIDENYCE POTTER ” Practice Location

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