Individual
STACEY PORTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
613 MARQUETTE RD, BRANDON, MS 39042-3038
(601) 824-1692
Mailing address
PO BOX 88, BRANDON, MS 39043-0088
(601) 824-1169
Taxonomy
Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
Primary
916128
MS
Other
Enumeration date
10/04/2022
Last updated
10/06/2022
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