Individual
MS. KELLI REBECCA PORTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
W.H.N.P. - B.C.
Contact information
Practice address
5656 BEE CAVES RD STE B101, WEST LAKE HILLS, TX 78746
(512) 301-6767
(512) 301-6776
Mailing address
5656 BEE CAVES RD STE B101, WEST LAKE HILLS, TX 78746-5281
(512) 301-6767
(512) 301-6776
Taxonomy
Speciality
Code
Description
License number
State
364SW0102X
Women's Health Clinical Nurse Specialist
Primary
NCC ID# JON104317267
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1529885
—
LA
01
—
36958
CDS LICENSE
LA
01
—
5H631DF29
MEDICARE GROUPT#
LA
01
—
80052
PRESCRIPTIVE AUTHORITY#
LA
01
—
AP04630
LA STATE BOARD OF NURSING - ADVANCED PRACTICE REGISTERED NURSE
LA
01
—
P01155808
MEDICARE RAILROAD PTAN
LA
01
—
RN157053
WH NURSE PRACTIONER LICEN
GA
Enumeration date
07/28/2005
Last updated
03/07/2023
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