Individual
SAMANTHA PORTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 984-5005
Mailing address
1601 GREENE ST, COLUMBIA, SC 29208-4001
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
906538
MS
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
08/23/2023
Last updated
04/19/2024
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