Individual
MRS. KEYONNA MARIE PORTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1114 N MAIN ST, SUMMERVILLE, SC 29483-7326
(843) 212-8070
(843) 212-8071
Mailing address
PO BOX 751649, CHARLOTTE, NC 28275-1649
(888) 472-0043
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
20196
SC
363LF0000X
Family Nurse Practitioner
1689133
WI
363LF0000X
Family Nurse Practitioner
Primary
20196
SC
363LF0000X
Family Nurse Practitioner
325161
AZ
363LF0000X
Family Nurse Practitioner
4040124
KY
363LF0000X
Family Nurse Practitioner
71593
NM
363LF0000X
Family Nurse Practitioner
887860
NV
363LF0000X
Family Nurse Practitioner
9571459
ID
390200000X
Student in an Organized Health Care Education/Training Program
204921
SC
Other
Enumeration date
04/07/2016
Last updated
09/11/2025
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