Healthcare Provider Details

I. General information

NPI: 1265243000
Provider Name (Legal Business Name): BARRY PORTER RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2025
Last Update Date: 01/20/2025
Certification Date: 01/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 COUNTY ROAD 79
STRINGER MS
39481-4550
US

IV. Provider business mailing address

611 COUNTY ROAD 79
STRINGER MS
39481-4550
US

V. Phone/Fax

Practice location:
  • Phone: 225-485-4306
  • Fax:
Mailing address:
  • Phone: 225-485-4306
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1-091426
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN108963
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: