Provider Demographics
NPI:1497294532
Name:RISPER, PORTIA (FNP-BC)
Entity Type:Individual
Prefix:MS
First Name:PORTIA
Middle Name:
Last Name:RISPER
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 S PINE HILL RD
Mailing Address - Street 2:APT H6
Mailing Address - City:GRIFFIN
Mailing Address - State:GA
Mailing Address - Zip Code:30224-8325
Mailing Address - Country:US
Mailing Address - Phone:404-561-2505
Mailing Address - Fax:
Practice Address - Street 1:600 S PINE HILL RD
Practice Address - Street 2:APT H6
Practice Address - City:GRIFFIN
Practice Address - State:GA
Practice Address - Zip Code:30224-8325
Practice Address - Country:US
Practice Address - Phone:404-561-2505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-22
Last Update Date:2017-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN220348363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily