Porter, Wanderful
Porter, Wanderful is an individual health care provider with primary practice located at 602 Brunson Dr , Tupelo MS 38801-4947. She recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as her primary health care specialty. Porter, Wanderful can be contacted via phone (662) 680-3855.Contact Information
Primary practice address
602 Brunson Dr
Tupelo MS 38801-4947
Phone: (662) 680-3855
Fax: (662) 680-3372
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Family Medicine | 207Q00000X | R748355 | Mississippi |
Profile Details
| NPI number | 1407833221 |
|---|---|
| LBN Legal business name | Porter, Wanderful |
| Credentials | FNP-BC |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Dec 22nd, 2005 |
| Last updated | Jun 9th, 2016 - about 9 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1407833221 | NPPES |
| Mississippi | MEDICAID | 00124068 |
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