Individual
MRS. MARY ELLEN PORTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1020 RIVER OAKS DR STE 100, FLOWOOD, MS 39232-9511
(601) 326-8700
(601) 932-4681
Mailing address
1020 RIVER OAKS DR STE 100, FLOWOOD, MS 39232-9511
(601) 326-8700
(601) 932-4681
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN098282
LA
363L00000X
Nurse Practitioner
Primary
AP04559
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
437505741B
—
LA
Enumeration date
02/02/2007
Last updated
09/11/2020
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