Healthcare Provider Details

I. General information

NPI: 1891552758
Provider Name (Legal Business Name): LAURA AGNES PORTER FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2024
Last Update Date: 07/24/2025
Certification Date: 07/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17053 S OUTER RD. 1ST FLOOR
BELTON MO
64012-2185
US

IV. Provider business mailing address

PO BOX 749495
ATLANTA GA
30374-9495
US

V. Phone/Fax

Practice location:
  • Phone: 816-974-5050
  • Fax: 816-388-9369
Mailing address:
  • Phone: 855-963-2100
  • Fax: 813-321-1296

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number2024008620
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number53-82966-101
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: