Individual
ANGEL PORTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
3303 FERN VALLEY RD, LOUISVILLE, KY 40213-3529
(502) 964-4889
Mailing address
PO BOX 950248, LOUISVILLE, KY 40295-0248
(502) 489-5730
(502) 489-5753
Taxonomy
Speciality
Code
Description
License number
State
2083X0100X
Occupational Medicine Physician
PA637
KY
363A00000X
Physician Assistant
Primary
PA637
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PA637
PA LICENSE
KY
Enumeration date
05/29/2007
Last updated
01/17/2015
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