MEDICARE: BRENA POTTS

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	106S00000X	Behavior Technician	25-499895

General Provider Information

NPI Number	:	1619826989
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRENA POTTS

Provider Business Mailing Address
First Line	:	107 S CAMBRIDGE ST
Second Line	:
City	:	HUBERT
State	:	NC
Zip	:	28539-9700
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	43 OFFICE PARK DR
Second Line	:
City	:	JACKSONVILLE
State	:	NC
Zip	:	28546-3220
Country	:	US
Telephone Number	:	888-392-8642
Fax Number	:	888-783-7611

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/28/2026
Last Update Date	:	01/28/2026

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Directions to “ BRENA POTTS ” Practice Location

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