Healthcare Provider Details

I. General information

NPI: 1073871083
Provider Name (Legal Business Name): HILLARY PORTER DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2012
Last Update Date: 04/08/2024
Certification Date: 04/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 MEDICAL CENTER DR FL 3R
HUNTINGTON WV
25701-3656
US

IV. Provider business mailing address

118 PRIVATE DRIVE 963
IRONTON OH
45638-9123
US

V. Phone/Fax

Practice location:
  • Phone: 304-691-1300
  • Fax:
Mailing address:
  • Phone: 740-646-0470
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number03943
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number3195
License Number StateWV
# 3
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number34.016245
License Number StateOH
# 4
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number3195
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: