1245477124 NPI number — MS. PAMELA SUE PORTER RNC, WHNP

Table of content: MS. PAMELA SUE PORTER RNC, WHNP (NPI 1245477124)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245477124 NPI number — MS. PAMELA SUE PORTER RNC, WHNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PORTER
Provider First Name:
PAMELA
Provider Middle Name:
SUE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
RNC, WHNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1245477124
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/14/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3030 NORTH ST
Provider Second Line Business Mailing Address:
SUITE 312
Provider Business Mailing Address City Name:
BEAUMONT
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77702-1433
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
409-899-5439
Provider Business Mailing Address Fax Number:
409-899-9915

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3030 NORTH ST
Provider Second Line Business Practice Location Address:
SUITE 312
Provider Business Practice Location Address City Name:
BEAUMONT
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77702-1434
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
409-899-5439
Provider Business Practice Location Address Fax Number:
409-899-9915
Provider Enumeration Date:
01/14/2009

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: 363LW0102X , with the licence number:  555426 , 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)





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