Provider Demographics
NPI:1922880251
Name:PORTER, NATHAN (PMHNP-BC)
Entity Type:Individual
Prefix:MR
First Name:NATHAN
Middle Name:
Last Name:PORTER
Suffix:
Gender:M
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9371 W ROBIN LN
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85383-2989
Mailing Address - Country:US
Mailing Address - Phone:602-326-6337
Mailing Address - Fax:
Practice Address - Street 1:34225 N 27TH DR STE 140
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85085-6090
Practice Address - Country:US
Practice Address - Phone:623-688-1508
Practice Address - Fax:602-698-9668
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-20
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ299058363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty