Provider Demographics
NPI:1518105626
Name:POTTER, KARA M (NP)
Entity Type:Individual
Prefix:
First Name:KARA
Middle Name:M
Last Name:POTTER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1835 CUNNINGHAM AVE
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95122-1712
Mailing Address - Country:US
Mailing Address - Phone:408-347-5988
Mailing Address - Fax:408-347-6019
Practice Address - Street 1:5671 SANTA TERESA BOULEVARD
Practice Address - Street 2:SUITE 15
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95123
Practice Address - Country:US
Practice Address - Phone:408-284-2281
Practice Address - Fax:408-281-2857
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-27
Last Update Date:2009-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15275261QC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health