1245314350 NPI number — MS. STEPHANIE PORTER PORTER MATTHEWS RNC, MSN, NNP

Table of content: MS. STEPHANIE PORTER PORTER MATTHEWS RNC, MSN, NNP (NPI 1245314350)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245314350 NPI number — MS. STEPHANIE PORTER PORTER MATTHEWS RNC, MSN, NNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PORTER MATTHEWS
Provider First Name:
STEPHANIE
Provider Middle Name:
PORTER
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
RNC, MSN, NNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PORTER
Provider Other First Name:
STEPHANIE
Provider Other Middle Name:
LANE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1245314350
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/07/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4213 BOULDER PARK DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EULESS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76040-8515
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
817-271-0352
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1935 MEDICAL DISTRICT DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75235-7701
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-456-7000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/25/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LN0000X , with the licence number:  526518 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 526518 . This is a "REGISTERED NURSE/APN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: MAT1-0429-7749 . This is a "NCC CERT." identifier . This identifiers is of the category "OTHER".