Provider Demographics
NPI:1104017755
Name:LINTON, PORNSON P (ANP (FNP))
Entity Type:Individual
Prefix:MRS
First Name:PORNSON
Middle Name:P
Last Name:LINTON
Suffix:
Gender:F
Credentials:ANP (FNP)
Other - Prefix:MS
Other - First Name:PORNSON
Other - Middle Name:
Other - Last Name:PEAUSUPARN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ANP (FNP)
Mailing Address - Street 1:1549 SECOND ST.
Mailing Address - Street 2:
Mailing Address - City:HAINES
Mailing Address - State:AK
Mailing Address - Zip Code:99827-0314
Mailing Address - Country:US
Mailing Address - Phone:907-766-6374
Mailing Address - Fax:907-766-3643
Practice Address - Street 1:1549 SECOND ST.
Practice Address - Street 2:
Practice Address - City:HAINES
Practice Address - State:AK
Practice Address - Zip Code:99827-0314
Practice Address - Country:US
Practice Address - Phone:907-766-6374
Practice Address - Fax:907-766-3643
Is Sole Proprietor?:No
Enumeration Date:2007-08-08
Last Update Date:2008-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK870363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKNP8606Medicaid
AK8EB787Medicare PIN
AK8EB783Medicare PIN
AKNP8606Medicaid
AK8EB786Medicare PIN
AK8EB785Medicare PIN
AK8EB784Medicare PIN