Provider Demographics
NPI:1609113760
Name:PORTERFIELD, KRYSTEN
Entity Type:Individual
Prefix:
First Name:KRYSTEN
Middle Name:
Last Name:PORTERFIELD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7137 PIPERS RUN PL
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89084-3158
Mailing Address - Country:US
Mailing Address - Phone:702-335-3370
Mailing Address - Fax:
Practice Address - Street 1:7137 PIPERS RUN PL
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89084-3158
Practice Address - Country:US
Practice Address - Phone:702-335-3370
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-09
Last Update Date:2013-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health