Provider Demographics
NPI:1568572691
Name:PORTER, GAYLE (CNS)
Entity Type:Individual
Prefix:
First Name:GAYLE
Middle Name:
Last Name:PORTER
Suffix:
Gender:F
Credentials:CNS
Other - Prefix:
Other - First Name:GAYLE
Other - Middle Name:
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 22000
Mailing Address - Street 2:
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76902-7200
Mailing Address - Country:US
Mailing Address - Phone:325-658-1511
Mailing Address - Fax:325-481-2165
Practice Address - Street 1:102 N MAGDALEN ST
Practice Address - Street 2:
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76903-5400
Practice Address - Country:US
Practice Address - Phone:325-658-8643
Practice Address - Fax:325-658-8645
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2012-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX573260364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8N7133OtherBCBS OF TEXAS
TX8N7133OtherBCBS OF TEXAS
TXQ32719Medicare UPIN