Healthcare Provider Details

I. General information

NPI: 1740165570
Provider Name (Legal Business Name): CHRISTINE L PORTER PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2025
Last Update Date: 08/08/2026
Certification Date: 08/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1674 W TUALATIN DRIVE N/A
POST FALLS ID
83854
US

IV. Provider business mailing address

1674 W TUALATIN DR # A
POST FALLS ID
83854-5187
US

V. Phone/Fax

Practice location:
  • Phone: 208-777-5248
  • Fax:
Mailing address:
  • Phone: 208-777-5248
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number3581123
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number76275
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: