Provider Demographics
NPI:1922800333
Name:PORTER, AMY NICOLE (RN CWS)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:NICOLE
Last Name:PORTER
Suffix:
Gender:F
Credentials:RN CWS
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:PORTER
Other - Last Name:LEIGHTON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN CWS
Mailing Address - Street 1:PO BOX 207
Mailing Address - Street 2:
Mailing Address - City:CRADDOCKVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23341-0207
Mailing Address - Country:US
Mailing Address - Phone:757-331-0084
Mailing Address - Fax:
Practice Address - Street 1:26181 PARKSLEY RD
Practice Address - Street 2:
Practice Address - City:PARKSLEY
Practice Address - State:VA
Practice Address - Zip Code:23421-3723
Practice Address - Country:US
Practice Address - Phone:757-331-0084
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-26
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001222756163WW0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WW0000XNursing Service ProvidersRegistered NurseWound Care