Provider Demographics
NPI:1265243000
Name:PORTER, BARRY (RN)
Entity type:Individual
Prefix:
First Name:BARRY
Middle Name:
Last Name:PORTER
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 COUNTY ROAD 79
Mailing Address - Street 2:
Mailing Address - City:STRINGER
Mailing Address - State:MS
Mailing Address - Zip Code:39481-4550
Mailing Address - Country:US
Mailing Address - Phone:225-485-4306
Mailing Address - Fax:
Practice Address - Street 1:611 COUNTY ROAD 79
Practice Address - Street 2:
Practice Address - City:STRINGER
Practice Address - State:MS
Practice Address - Zip Code:39481-4550
Practice Address - Country:US
Practice Address - Phone:225-485-4306
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-20
Last Update Date:2025-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-091426163W00000X
LARN108963163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse