Provider Demographics
NPI:1437197647
Name:PORTER, JOHN C (NP-C)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:C
Last Name:PORTER
Suffix:
Gender:M
Credentials:NP-C
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Mailing Address - Street 1:3544 E 17TH ST
Mailing Address - Street 2:STE 104
Mailing Address - City:AMMON
Mailing Address - State:ID
Mailing Address - Zip Code:83406-6910
Mailing Address - Country:US
Mailing Address - Phone:208-522-2922
Mailing Address - Fax:208-522-6330
Practice Address - Street 1:444 HOSPITAL WAY
Practice Address - Street 2:SUITE 801
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201-2745
Practice Address - Country:US
Practice Address - Phone:800-613-4012
Practice Address - Fax:208-233-3416
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2016-05-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IDNP376A363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care