Individual
WENDELL KEITH PORTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1105 OAK CLUSTER DR, SEVIERVILLE, TN 37862-6079
(865) 908-3636
(865) 908-3644
Mailing address
1105 OAK CLUSTER DR, SEVIERVILLE, TN 37862-6079
(865) 908-3636
(865) 908-3644
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
NCCPA:1040254
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0626PA
—
SC
Enumeration date
01/23/2006
Last updated
06/25/2014
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