Provider Demographics
NPI:1174075360
Name:PORTER, LAKENDRA (NP)
Entity type:Individual
Prefix:
First Name:LAKENDRA
Middle Name:
Last Name:PORTER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5450 HIGHWAY 153 STE 126
Mailing Address - Street 2:
Mailing Address - City:HIXSON
Mailing Address - State:TN
Mailing Address - Zip Code:37343-3791
Mailing Address - Country:US
Mailing Address - Phone:865-201-7035
Mailing Address - Fax:865-761-2726
Practice Address - Street 1:5450 HIGHWAY 153 STE 126
Practice Address - Street 2:
Practice Address - City:HIXSON
Practice Address - State:TN
Practice Address - Zip Code:37343-3791
Practice Address - Country:US
Practice Address - Phone:865-201-7035
Practice Address - Fax:865-761-2726
Is Sole Proprietor?:No
Enumeration Date:2016-11-04
Last Update Date:2022-08-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN21590363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily