Healthcare Provider Details

I. General information

NPI: 1881364875
Provider Name (Legal Business Name): PATRICIA ANN PORTER CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2021
Last Update Date: 09/20/2021
Certification Date: 09/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 E WASHINGTON AVE
JONESBORO AR
72401-3111
US

IV. Provider business mailing address

2103 SWEET GUM DR
JONESBORO AR
72401-3692
US

V. Phone/Fax

Practice location:
  • Phone: 870-207-4100
  • Fax:
Mailing address:
  • Phone: 870-530-0655
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number217601
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: