MEDICARE: LAKENDRA PORTER NP

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
1	363LF0000X	Family Nurse Practitioner	21590	TN

General Provider Information

NPI Number	:	1174075360
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAKENDRA PORTER NP

Provider Business Mailing Address
First Line	:	5450 HIGHWAY 153 STE 126
Second Line	:
City	:	HIXSON
State	:	TN
Zip	:	37343-3791
Country	:	US
Telephone Number	:	865-201-7035
Fax Number	:	865-761-2726

Provider Business Practice Location Address
First Line	:	5450 HIGHWAY 153 STE 126
Second Line	:
City	:	HIXSON
State	:	TN
Zip	:	37343-3791
Country	:	US
Telephone Number	:	865-201-7035
Fax Number	:	865-761-2726

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/04/2016
Last Update Date	:	08/26/2022

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Directions to “ LAKENDRA PORTER NP” Practice Location

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