Provider Demographics
NPI:1497089403
Name:PORTER, AMBER REESE (DNP, FNP)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:REESE
Last Name:PORTER
Suffix:
Gender:F
Credentials:DNP, FNP
Other - Prefix:
Other - First Name:AMBER
Other - Middle Name:K
Other - Last Name:REESE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1300 N 12TH ST STE 605
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85006-2850
Mailing Address - Country:US
Mailing Address - Phone:602-839-4567
Mailing Address - Fax:602-839-2232
Practice Address - Street 1:1300 N 12TH ST STE 605
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006-2850
Practice Address - Country:US
Practice Address - Phone:602-839-4567
Practice Address - Fax:602-839-2232
Is Sole Proprietor?:No
Enumeration Date:2009-09-23
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN112226163W00000X
AZAP3498363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ474834Medicaid