Individual
KELLIE A PORTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP-C
Contact information
Practice address
1876 E SABIN DR STE 10, CASA GRANDE, AZ 85122-6197
(520) 836-9800
(520) 836-1510
Mailing address
PO BOX 749495, ATLANTA, GA 30374-9495
(866) 266-0555
(866) 266-4999
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
AP4957
AZ
363LF0000X
Family Nurse Practitioner
AP4957
AZ
Other
Enumeration date
05/31/2013
Last updated
07/07/2022
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