Provider Demographics
NPI:1154115129
Name:PORTER, TIFFANY (DNP)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:PORTER
Suffix:
Gender:
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 S DELLROSE AVE
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67218-1414
Mailing Address - Country:US
Mailing Address - Phone:702-884-4793
Mailing Address - Fax:
Practice Address - Street 1:3610 E ROSS PKWY
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67210-1311
Practice Address - Country:US
Practice Address - Phone:216-866-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-07
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS5383978091363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily