Provider Demographics
NPI:1043291560
Name:PORCHIA, DEBORAH L
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:L
Last Name:PORCHIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 E 6TH ST
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:AR
Mailing Address - Zip Code:71854-5207
Mailing Address - Country:US
Mailing Address - Phone:870-779-6000
Mailing Address - Fax:870-779-6125
Practice Address - Street 1:300 E 6TH ST
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:AR
Practice Address - Zip Code:71854-5207
Practice Address - Country:US
Practice Address - Phone:870-779-6000
Practice Address - Fax:870-779-6125
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2013-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR22115363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR141066758Medicaid
TX175871601Medicaid
TX809799Medicare ID - Type Unspecified
P17731Medicare UPIN
TX175871601Medicaid