Provider Demographics
NPI:1881696417
Name:PORTER, LAURA L (FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:L
Last Name:PORTER
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:MS
Other - First Name:LAURA
Other - Middle Name:LYNN
Other - Last Name:SUTTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-BC
Mailing Address - Street 1:615 DERBY ST
Mailing Address - Street 2:ATTENTION: HCS HI&R
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37404-1632
Mailing Address - Country:US
Mailing Address - Phone:423-493-2906
Mailing Address - Fax:423-493-2950
Practice Address - Street 1:615 DERBY ST
Practice Address - Street 2:ATTENTION: HCS HI&R
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37404-1632
Practice Address - Country:US
Practice Address - Phone:423-493-2906
Practice Address - Fax:423-493-2950
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2013-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN70783363L00000X
TNAPN0000006060363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3902601Medicaid
TNP33828OtherRR MEDICARE
TN4020701OtherBLUE CROSS BLUE SHIELD
TNP33828Medicare UPIN
TNP33828OtherRR MEDICARE