Provider Demographics
NPI:1689658429
Name:PORTER, BETSY O (FNP)
Entity Type:Individual
Prefix:
First Name:BETSY
Middle Name:O
Last Name:PORTER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 660599
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75266-0599
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5201 HARRY HINES BLVD
Practice Address - Street 2:MEDICAL STAFF SERVICES
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75235-7708
Practice Address - Country:US
Practice Address - Phone:214-590-8006
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-05
Last Update Date:2008-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX232409363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX138628601Medicaid
TX138628605Medicaid
TX138628613Medicaid
TX138628603Medicaid
TX138628608Medicaid
TX138628604Medicaid
TX138628607Medicaid
TX138628612Medicaid
TX8Y0748OtherBLUE CROSS BLUE SHIELD
TX138628610Medicaid
TX138628602Medicaid
TX138628606Medicaid
TX138628611Medicaid
86N656Medicare PIN
TX8Y0748OtherBLUE CROSS BLUE SHIELD