Provider Demographics
NPI:1497369656
Name:POTTER, CHARITY ELAINE
Entity Type:Individual
Prefix:
First Name:CHARITY
Middle Name:ELAINE
Last Name:POTTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6592 BREEDEN CRK
Mailing Address - Street 2:
Mailing Address - City:BREEDEN
Mailing Address - State:WV
Mailing Address - Zip Code:25666-6610
Mailing Address - Country:US
Mailing Address - Phone:304-393-9481
Mailing Address - Fax:
Practice Address - Street 1:6592 BREEDEN CRK
Practice Address - Street 2:
Practice Address - City:BREEDEN
Practice Address - State:WV
Practice Address - Zip Code:25666-6610
Practice Address - Country:US
Practice Address - Phone:304-393-9481
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-04
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant