Healthcare Provider Details

I. General information

NPI: 1124168992
Provider Name (Legal Business Name): BETTY MELISSA PORTER ARNP, CFNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

575 SUGAR LOAF MOUNTAIN RD
MOREHEAD KY
40351-9177
US

IV. Provider business mailing address

575 SUGAR LOAF MOUNTAIN RD
MOREHEAD KY
40351-9177
US

V. Phone/Fax

Practice location:
  • Phone: 606-784-9177
  • Fax: 606-780-4622
Mailing address:
  • Phone: 606-784-5384
  • Fax: 606-780-4622

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2124P
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: