Provider Demographics
NPI:1386262707
Name:PORTER, RACHEL MARIE (APRN, FNP-C)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:MARIE
Last Name:PORTER
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:ANDOVER FAMILY MEDICINE
Mailing Address - Street 2:2117 N KEYSTONE CIRCLE
Mailing Address - City:ANDOVER
Mailing Address - State:KS
Mailing Address - Zip Code:67002
Mailing Address - Country:US
Mailing Address - Phone:316-733-5120
Mailing Address - Fax:316-733-1280
Practice Address - Street 1:ANDOVER FAMILY MEDICINE
Practice Address - Street 2:2117 N KEYSTONE CIRCLE
Practice Address - City:ANDOVER
Practice Address - State:KS
Practice Address - Zip Code:67002
Practice Address - Country:US
Practice Address - Phone:316-733-5120
Practice Address - Fax:316-733-1280
Is Sole Proprietor?:No
Enumeration Date:2020-07-13
Last Update Date:2020-07-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS53-79448031363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily