Healthcare Provider Details

I. General information

NPI: 1154435741
Provider Name (Legal Business Name): CATHY PORTER APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1165 HIGHWAY 1 S SUITE 400
LUGOFF SC
29078-8966
US

IV. Provider business mailing address

645 S SEVENTH ST PO BOX 366
MC BEE SC
29101-7101
US

V. Phone/Fax

Practice location:
  • Phone: 803-408-3262
  • Fax: 803-408-8895
Mailing address:
  • Phone: 843-335-6756
  • Fax: 843-335-8731

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF2731
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: