Provider Demographics
NPI:1154435741
Name:PORTER, CATHY (APRN)
Entity type:Individual
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First Name:CATHY
Middle Name:
Last Name:PORTER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
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Mailing Address - Street 1:645 S SEVENTH ST
Mailing Address - Street 2:PO BOX 366
Mailing Address - City:MC BEE
Mailing Address - State:SC
Mailing Address - Zip Code:29101-7101
Mailing Address - Country:US
Mailing Address - Phone:843-335-6756
Mailing Address - Fax:843-335-8731
Practice Address - Street 1:1165 HIGHWAY 1 S
Practice Address - Street 2:SUITE 400
Practice Address - City:LUGOFF
Practice Address - State:SC
Practice Address - Zip Code:29078-8966
Practice Address - Country:US
Practice Address - Phone:803-408-3262
Practice Address - Fax:803-408-8895
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2023-03-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
SCF2731363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCF2731OtherSTATE LICENSE
SCMP1239210OtherDEA
SCQ51894Medicare UPIN