Healthcare Provider Details

I. General information

NPI: 1841758422
Provider Name (Legal Business Name): LIVINA PORTER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/04/2019
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 WESTCHESTER DR
HIGH POINT NC
27262-7374
US

IV. Provider business mailing address

1801 WESTCHESTER DR
HIGH POINT NC
27262-7009
US

V. Phone/Fax

Practice location:
  • Phone: 336-889-8446
  • Fax:
Mailing address:
  • Phone: 336-889-8446
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5011548
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code163WH1000X
TaxonomyHospice Registered Nurse
License Number253960
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: