Healthcare Provider Details

I. General information

NPI: 1336614957
Provider Name (Legal Business Name): MONICA N. PORTER FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2018
Last Update Date: 11/18/2021
Certification Date: 11/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1690 MEDICAL CENTER DRIVE
HUNTINGTON WV
25701
US

IV. Provider business mailing address

1690 MEDICAL CENTER DRIVE MARSHALL KIDNEY CARE & HYPERTENSION CENTER
HUNTINGTON WV
25702
US

V. Phone/Fax

Practice location:
  • Phone: 304-526-2532
  • Fax:
Mailing address:
  • Phone: 304-526-2532
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN47741NP
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: