Provider Demographics
NPI:1790498574
Name:PORTER, CARLEY (AGACNP-BC)
Entity Type:Individual
Prefix:
First Name:CARLEY
Middle Name:
Last Name:PORTER
Suffix:
Gender:F
Credentials:AGACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:925 OAK CLIFF DR
Mailing Address - Street 2:
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-5044
Mailing Address - Country:US
Mailing Address - Phone:443-786-0491
Mailing Address - Fax:
Practice Address - Street 1:1801 INWOOD RD FL 7
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75235-7202
Practice Address - Country:US
Practice Address - Phone:214-645-2900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-27
Last Update Date:2022-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1102141363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care