Individual
MRS. ANN MICHELLE PORTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
766 LAKELAND DR # A, JACKSON, MS 39216-4610
(601) 368-3440
(601) 368-3441
Mailing address
6255 W SUNSET BLVD FL 21, LOS ANGELES, CA 90028-7422
(323) 860-5200
(323) 467-7119
Taxonomy
Speciality
Code
Description
License number
State
207RI0200X
Infectious Disease Physician
R822501
MS
363L00000X
Nurse Practitioner
Primary
R822501
MS
363LF0000X
Family Nurse Practitioner
R822501
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0292891-22
BOARD CERTIFICATION
MS
05
—
03258395
—
MS
01
—
R822501
NURSING LICENSE
MS
Enumeration date
08/09/2007
Last updated
05/08/2024
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