Provider Demographics
NPI:1093051450
Name:KP ACUPUNCTURE, INC.
Entity Type:Organization
Organization Name:KP ACUPUNCTURE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACUPUNCTURE PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:POTTS
Authorized Official - Suffix:
Authorized Official - Credentials:DOM, AP
Authorized Official - Phone:813-765-2493
Mailing Address - Street 1:112 EVELYN AVE
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33765-4303
Mailing Address - Country:US
Mailing Address - Phone:813-765-2493
Mailing Address - Fax:
Practice Address - Street 1:112 EVELYN AVE
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33765-4303
Practice Address - Country:US
Practice Address - Phone:813-765-2493
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-12
Last Update Date:2012-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3176305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization