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General NPI Number Information
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NPI Number | 1215458328
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Entity Type | Individual
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Provider Name | KELSEY PORTER MD
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Gender | Female
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Dates
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Enumeration Date | 06/28/2017
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Last Update Date | 03/27/2025
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Provider Practice Location Address
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Address Line | 101 AVENUE O SE
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City | WINTER HAVEN
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State | FL
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Zip | 33880-4333
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Country | US
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Telephone | 863-294-7010
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Fax |
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Provider Business Mailing Address
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Address Line | 101 AVENUE O SE
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City | WINTER HAVEN
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State | FL
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Zip | 33880-4333
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 009668
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | ME167024
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License Number State | FL
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