Provider Demographics
NPI:1437331873
Name:PORTER, KELLY (PA-C)
Entity Type:Individual
Prefix:MS
First Name:KELLY
Middle Name:
Last Name:PORTER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 ORCHARD DR
Mailing Address - Street 2:
Mailing Address - City:TRAFFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15085-1640
Mailing Address - Country:US
Mailing Address - Phone:412-856-7332
Mailing Address - Fax:
Practice Address - Street 1:101 ORCHARD DR
Practice Address - Street 2:
Practice Address - City:TRAFFORD
Practice Address - State:PA
Practice Address - Zip Code:15085-1640
Practice Address - Country:US
Practice Address - Phone:412-856-7332
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-28
Last Update Date:2012-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA053045363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant