Individual
MR. LEE W PORTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP, CNS-PMH
Contact information
Practice address
5305 RIVER RD N STE B, KEIZER, OR 97303-5324
(541) 896-1555
Mailing address
65 DIVISION AVE UNIT 299, EUGENE, OR 97404-2485
(541) 896-1555
(888) 562-3550
Taxonomy
Speciality
Code
Description
License number
State
2084N0600X
Clinical Neurophysiology Physician
163552
NC
208VP0000X
Pain Medicine Physician
202002489CNS-PP
OR
363LA2200X
Adult Health Nurse Practitioner
201501835NP-PP
OR
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
202002489CNS-PP
OR
364SP0808X
Psychiatric/Mental Health Clinical Nurse Specialist
201501835NP-PP
OR
364SP0809X
Adult Psychiatric/Mental Health Clinical Nurse Specialist
202002489CNS-PP
OR
364SP0811X
Chronically Ill Psychiatric/Mental Health Clinical Nurse Specialist
201501835NP-PP
OR
364SP0813X
Geropsychiatric Psychiatric/Mental Health Clinical Nurse Specialist
202002489CNS-PP
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
131VX
BLUE CROSS PROVIDER ID
NC
01
—
3072541580
PECOS PAC ID
OR
05
—
500709395
—
OR
01
—
I20160510002557
PECOS PAC ENROLLMENT ID
OR
Enumeration date
07/13/2006
Last updated
12/20/2022
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