MEDICARE: MS. KATHY ADRIANNE COOK PORTER NP

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
1	363LW0102X	Women's Health Nurse Practitioner	AP111291	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568465136
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KATHY ADRIANNE COOK PORTER NP

Provider Business Mailing Address
First Line	:	3450 W WHEATLAND RD STE 440
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75237-4417
Country	:	US
Telephone Number	:	972-298-4300
Fax Number	:	972-298-8903

Provider Business Practice Location Address
First Line	:	3450 W WHEATLAND RD STE 440
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75237-4417
Country	:	US
Telephone Number	:	972-298-4300
Fax Number	:	972-298-8903

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/27/2005
Last Update Date	:	03/22/2024

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