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NPI Code Detail

MEDICARE: MS. KELLY PORTER PA-C

MEDICARE: MS. KELLY PORTER PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician AssistantMA053045PA

General Provider Information

NPI Number : 1437331873
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. KELLY PORTER PA-C
Provider Business Mailing Address
First Line : 101 ORCHARD DR
Second Line :
City : TRAFFORD
State : PA
Zip : 15085-1640
Country : US
Telephone Number : 412-856-7332
Fax Number :
Provider Business Practice Location Address
First Line : 101 ORCHARD DR
Second Line :
City : TRAFFORD
State : PA
Zip : 15085-1640
Country : US
Telephone Number : 412-856-7332
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/28/2007
Last Update Date : 12/17/2012

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Directions to “ MS. KELLY PORTER PA-C” Practice Location

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