Individual
MRS. JESSICA LOUISE PORTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PNP-PC
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
0001303524
VA
163W00000X
Registered Nurse
RN1040218
DC
363LP0200X
Pediatric Nurse Practitioner
Primary
0024185704
VA
Other
Enumeration date
03/22/2021
Last updated
12/02/2022
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