Provider Demographics
NPI:1720664469
Name:POTTER, KAYLEE GRACE (DO)
Entity type:Individual
Prefix:
First Name:KAYLEE
Middle Name:GRACE
Last Name:POTTER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:KAYLEE
Other - Middle Name:GRACE
Other - Last Name:BAUMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:999 S FAIRMONT AVE STE 130
Mailing Address - Street 2:
Mailing Address - City:LODI
Mailing Address - State:CA
Mailing Address - Zip Code:95240-5141
Mailing Address - Country:US
Mailing Address - Phone:209-334-3333
Mailing Address - Fax:
Practice Address - Street 1:945 N 12TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53233-1305
Practice Address - Country:US
Practice Address - Phone:414-219-5725
Practice Address - Fax:414-219-5611
Is Sole Proprietor?:No
Enumeration Date:2021-03-23
Last Update Date:2025-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23659207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology