Provider Demographics
NPI:1174546758
Name:PORTER, MARY MARGARET (APRN,CFNP)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:MARGARET
Last Name:PORTER
Suffix:
Gender:F
Credentials:APRN,CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 247
Mailing Address - Street 2:9879 KENTUCKY ROUTE 122
Mailing Address - City:MC DOWELL
Mailing Address - State:KY
Mailing Address - Zip Code:41647-0247
Mailing Address - Country:US
Mailing Address - Phone:606-377-3427
Mailing Address - Fax:606-377-3466
Practice Address - Street 1:9879 KY RT 122
Practice Address - Street 2:
Practice Address - City:MC DOWELL
Practice Address - State:KY
Practice Address - Zip Code:41647-0247
Practice Address - Country:US
Practice Address - Phone:606-377-3427
Practice Address - Fax:606-377-3492
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2011-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1043721363LF0000X
KY2505P363LF0000X
KY285898-22363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYT49711Medicare UPIN