Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC1500X | Nurse Practitioner - Community Health | 53-78383-111 | KS |
NPI | 1609333509 |
---|---|
Provider Name | Estacy Porter |
First Address | Fort Leavenworth, KS 66027-1421 |
Second Address | Fort Leavenworth, KS 66027-1421 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/02/2019 |
Last Update Date | 27/02/2019 |