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NPI Code Detail

MEDICARE: KIRSTEN POTTS

MEDICARE:   KIRSTEN  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
12255A2300XAthletic Trainer
2390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1891179016
Entity Type Code : Individual
Provider Name (Legal Business Name) : KIRSTEN POTTS
Provider Business Mailing Address
First Line : 16619 FORT OSWEGO ST
Second Line :
City : SAN ANTONIO
State : TX
Zip : 78247-1033
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 16619 FORT OSWEGO ST
Second Line :
City : SAN ANTONIO
State : TX
Zip : 78247-1033
Country : US
Telephone Number : 210-391-2976
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/17/2015
Last Update Date : 07/17/2015

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Directions to “ KIRSTEN POTTS ” Practice Location

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