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General NPI Number Information
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NPI Number | 1891159794
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Entity Type | Individual
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Provider Name | KEYONNA MARIE PORTER NP
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Gender | Female
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Dates
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Enumeration Date | 04/07/2016
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 1114 N MAIN ST
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City | SUMMERVILLE
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State | SC
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Zip | 29483-7326
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Country | US
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Telephone | 843-212-8070
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Fax | 843-212-8071
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Provider Business Mailing Address
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Address Line | PO BOX 751649
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City | CHARLOTTE
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State | NC
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Zip | 28275-1649
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Country | US
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Telephone | 888-472-0043
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 20196
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License Number State | SC
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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 | 4040124
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License Number State | KY
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Taxonomy #3
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | 204921
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License Number State | SC
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Taxonomy #4
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 325161
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License Number State | AZ
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Taxonomy #5
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 71593
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License Number State | NM
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Taxonomy #6
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 1689133
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License Number State | WI
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Taxonomy #7
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 887860
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License Number State | NV
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Taxonomy #8
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 20196
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License Number State | SC
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Taxonomy #9
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 9571459
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License Number State | ID
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