Individual
WANDERFUL PORTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-BC
Contact information
Practice address
602 BRUNSON DR, TUPELO, MS 38801-4947
(662) 680-3855
(662) 680-3372
Mailing address
602 BRUNSON DR, TUPELO, MS 38801-4947
(662) 680-3855
(662) 680-3372
Taxonomy
Speciality
Code
Description
License number
State
363LP2300X
Primary Care Nurse Practitioner
Primary
R748355
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00124068
—
MS
Enumeration date
12/22/2005
Last updated
10/30/2024
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