Provider Demographics
NPI:1487623088
Name:PORTER, CHRISTY CARTY (FNP)
Entity type:Individual
Prefix:MRS
First Name:CHRISTY
Middle Name:CARTY
Last Name:PORTER
Suffix:
Gender:F
Credentials:FNP
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 2347
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:VA
Mailing Address - Zip Code:24266-2347
Mailing Address - Country:US
Mailing Address - Phone:276-889-7621
Mailing Address - Fax:276-889-7695
Practice Address - Street 1:75 ROGERS ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:VA
Practice Address - Zip Code:24266
Practice Address - Country:US
Practice Address - Phone:276-889-7621
Practice Address - Fax:276-889-7695
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2011-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024147370363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAS96374Medicare UPIN