Provider Demographics
NPI:1629401658
Name:PORTER, KATHERINE LEE ROURKE (ARNP)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:LEE ROURKE
Last Name:PORTER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 2699
Mailing Address - Street 2:SHMG/HPE
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32513-2699
Mailing Address - Country:US
Mailing Address - Phone:850-267-1603
Mailing Address - Fax:850-622-3342
Practice Address - Street 1:7720 US HIGHWAY 98 W
Practice Address - Street 2:SUITE 110
Practice Address - City:MIRAMAR BEACH
Practice Address - State:FL
Practice Address - Zip Code:32550-7230
Practice Address - Country:US
Practice Address - Phone:850-267-1603
Practice Address - Fax:850-622-3342
Is Sole Proprietor?:No
Enumeration Date:2013-08-13
Last Update Date:2016-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9301945363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care