Healthcare Provider Details

I. General information

NPI: 1962472076
Provider Name (Legal Business Name): MARY KAREN PORTERFIELD MSN, CFNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2006
Last Update Date: 10/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1930 BRAEBURN CIR
SALEM VA
24153-7388
US

IV. Provider business mailing address

189 THORNEY HOLLOW RD
NEW CASTLE VA
24127-7871
US

V. Phone/Fax

Practice location:
  • Phone: 540-772-4540
  • Fax: 540-772-6805
Mailing address:
  • Phone: 540-772-4540
  • Fax: 540-772-6805

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024164720
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: