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General NPI Number Information
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NPI Number | 1609333509
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Entity Type | Individual
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Provider Name | ESTACY PORTER DNP, FNP-C, PMHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 02/27/2019
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Last Update Date | 07/17/2025
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Provider Practice Location Address
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Address Line | 5121 WASHINGTON RD
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City | EVANS
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State | GA
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Zip | 30809-6448
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Country | US
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Telephone | 706-426-1642
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Fax |
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Provider Business Mailing Address
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Address Line | 6231 FREEDOM CIR STE 2
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City | GROVETOWN
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State | GA
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Zip | 30813-1213
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Country | US
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Telephone | 757-788-9578
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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 | 363LC1500X
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Taxonomy Name | Community Health Nurse Practitioner
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License Number | 53-78383-111
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License Number State | KS
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | RN200693
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | RN200693
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License Number State | GA
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