MEDICARE: KEVIN ALEXANDER PORTER RN

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	163W00000X	Registered Nurse	RN265376	GA

General Provider Information

NPI Number	:	1811863855
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEVIN ALEXANDER PORTER RN

Provider Business Mailing Address
First Line	:	935 CHESAPEAKE WAY
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31907-7340
Country	:	US
Telephone Number	:	706-615-5583
Fax Number	:

Provider Business Practice Location Address
First Line	:	935 CHESAPEAKE WAY
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31907-7340
Country	:	US
Telephone Number	:	706-615-5583
Fax Number	:

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

Provider Enumeration Date	:	10/16/2025
Last Update Date	:	10/16/2025

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