Healthcare Provider Details

I. General information

NPI: 1962573477
Provider Name (Legal Business Name): CAROLYN J. PORTER F.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 02/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1035 1ST AVE WEST FLATHEAD COMMUNITY HEALTH CENTER
KALISPELL MT
59901-5607
US

IV. Provider business mailing address

1035 1ST AVE WEST FLATHEAD COMMUNITY HEALTH CENTER
KALISPELL MT
59901-5607
US

V. Phone/Fax

Practice location:
  • Phone: 406-751-8155
  • Fax: 406-751-8151
Mailing address:
  • Phone: 406-751-8155
  • Fax: 406-751-8151

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LC1500X
TaxonomyCommunity Health Nurse Practitioner
License NumberR128490
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: