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NPI Code Detail

MEDICARE: CONNIE PORTER

MEDICARE: CONNIE PORTER
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1053244897
Entity Type Code : Individual
Provider Name (Legal Business Name) : CONNIE PORTER
Provider Business Mailing Address
First Line : 1679 N HIGHWAY 7
Second Line :
City : HOT SPRINGS VILLAGE
State : AR
Zip : 71909-9310
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1679 N HIGHWAY 7
Second Line :
City : HOT SPRINGS VILLAGE
State : AR
Zip : 71909-9310
Country : US
Telephone Number : 501-624-2446
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/03/2026
Last Update Date : 06/03/2026

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Directions to “ CONNIE PORTER ” Practice Location

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