Provider Demographics
NPI:1275067647
Name:PORTER, JESSICA
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:PORTER
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 1:315 LINCOLN ST
Mailing Address - Street 2:SUITE 207
Mailing Address - City:SITKA
Mailing Address - State:AK
Mailing Address - Zip Code:99835-7579
Mailing Address - Country:US
Mailing Address - Phone:907-747-2726
Mailing Address - Fax:907-747-6126
Practice Address - Street 1:315 LINCOLN ST
Practice Address - Street 2:SUITE 207
Practice Address - City:SITKA
Practice Address - State:AK
Practice Address - Zip Code:99835-7579
Practice Address - Country:US
Practice Address - Phone:907-747-2726
Practice Address - Fax:907-747-6126
Is Sole Proprietor?:No
Enumeration Date:2017-04-12
Last Update Date:2017-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist