Provider Demographics
NPI:1174344386
Name:PORTER, HENRY JR
Entity type:Individual
Prefix:MR
First Name:HENRY
Middle Name:
Last Name:PORTER
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 SUES LN
Mailing Address - Street 2:
Mailing Address - City:SYMSONIA
Mailing Address - State:KY
Mailing Address - Zip Code:42082-9466
Mailing Address - Country:US
Mailing Address - Phone:270-349-7700
Mailing Address - Fax:
Practice Address - Street 1:30 SUES LN
Practice Address - Street 2:
Practice Address - City:SYMSONIA
Practice Address - State:KY
Practice Address - Zip Code:42082-9466
Practice Address - Country:US
Practice Address - Phone:270-349-7700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-21
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services