Potter, Brent
Potter, Brent is an sole proprietor health care provider with primary practice located at 4182 N Bank St , Kingman AZ 86409-2715. He recently has only one registered license in Behavioral Health & Social Service Providers / School, which is considered as his primary health care specialty. Potter, Brent can be contacted via phone (928) 692-9813.Contact Information
Primary practice address
4182 N Bank St
Kingman AZ 86409-2715
Phone: (928) 692-9813
Fax: (928) 692-1507
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / School | 101YS0200X | Arizona |
Profile Details
| NPI number | 1871706481 |
|---|---|
| LBN Legal business name | Potter, Brent |
| Credentials | |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | May 8th, 2007 |
| Last updated | Jul 26th, 2007 - about 17 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1871706481 | NPPES |
| Arizona | MEDICAID | 961575 |
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