Provider Demographics
NPI:1962472076
Name:PORTERFIELD, MARY KAREN (MSN, CFNP)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:KAREN
Last Name:PORTERFIELD
Suffix:
Gender:F
Credentials:MSN, CFNP
Other - Prefix:
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Mailing Address - Street 1:189 THORNEY HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:VA
Mailing Address - Zip Code:24127-7871
Mailing Address - Country:US
Mailing Address - Phone:540-772-4540
Mailing Address - Fax:540-772-6805
Practice Address - Street 1:1930 BRAEBURN CIR
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:VA
Practice Address - Zip Code:24153-7388
Practice Address - Country:US
Practice Address - Phone:540-772-4540
Practice Address - Fax:540-772-6805
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2018-10-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0024164720363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA10163382Medicaid
VA007245P75Medicare ID - Type Unspecified
VA10163382Medicaid