MEDICARE: PAUL ANTHONY PORTER CRNP

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	363L00000X	Nurse Practitioner	1-132215	AL

General Provider Information

NPI Number	:	1184354110
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAUL ANTHONY PORTER CRNP

Provider Business Mailing Address
First Line	:	284 OUTBACK DR
Second Line	:
City	:	WEDOWEE
State	:	AL
Zip	:	36278-4075
Country	:	US
Telephone Number	:	256-557-8397
Fax Number	:

Provider Business Practice Location Address
First Line	:	1201 22ND ST N
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35234-2726
Country	:	US
Telephone Number	:	205-251-5271
Fax Number	:

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

Provider Enumeration Date	:	06/13/2022
Last Update Date	:	06/15/2022

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