MEDICARE: ANNA PORTER PMHNP- BC

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	1133171	TX

General Provider Information

NPI Number	:	1811759608
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNA PORTER PMHNP- BC

Provider Business Mailing Address
First Line	:	1218 E YANDELL DR STE 203
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79902-5527
Country	:	US
Telephone Number	:	915-549-1698
Fax Number	:	915-900-6019

Provider Business Practice Location Address
First Line	:	1218 E YANDELL DR STE 203
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79902-5527
Country	:	US
Telephone Number	:	915-373-8891
Fax Number	:	915-900-6019

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

Provider Enumeration Date	:	01/26/2024
Last Update Date	:	01/30/2026

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