Provider Demographics
NPI:1124485552
Name:POTTER, BRITTANY A (RD CDCES)
Entity type:Individual
Prefix:
First Name:BRITTANY
Middle Name:A
Last Name:POTTER
Suffix:
Gender:F
Credentials:RD CDCES
Other - Prefix:
Other - First Name:BRITTANY
Other - Middle Name:A
Other - Last Name:MCCAREL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD CD
Mailing Address - Street 1:1536 GREGORY LN
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:IN
Mailing Address - Zip Code:47546-9113
Mailing Address - Country:US
Mailing Address - Phone:812-887-4521
Mailing Address - Fax:
Practice Address - Street 1:1536 GREGORY LN
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:IN
Practice Address - Zip Code:47546-9113
Practice Address - Country:US
Practice Address - Phone:812-887-4521
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-15
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY275800133V00000X
FLND11182133V00000X
IN37002449A133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered