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General NPI Number Information
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NPI Number | 1528515814
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Entity Type | Individual
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Provider Name | AMY MELISSA PORTER ARNP
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Gender | Female
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Dates
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Enumeration Date | 09/05/2016
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Last Update Date | 11/15/2021
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Provider Practice Location Address
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Address Line | 21907 64TH AVE W STE 200
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City | MOUNTLAKE TERRACE
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State | WA
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Zip | 98043-6200
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Country | US
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Telephone | 407-473-1137
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Fax |
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Provider Business Mailing Address
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Address Line | 2619 BAKER AVE APT 1
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City | EVERETT
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State | WA
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Zip | 98201-3161
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Country | US
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Telephone | 317-695-8271
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | RN 9293127
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | AP60818369
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License Number State | WA
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