Provider Demographics
NPI:1528432689
Name:PORTER, ABBEY ELIZABETH (APRN, NP)
Entity type:Individual
Prefix:
First Name:ABBEY
Middle Name:ELIZABETH
Last Name:PORTER
Suffix:
Gender:F
Credentials:APRN, NP
Other - Prefix:
Other - First Name:ABBEY
Other - Middle Name:ELIZABETH
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN-NP
Mailing Address - Street 1:100 E LIBERTY ST
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-1434
Mailing Address - Country:US
Mailing Address - Phone:502-895-1489
Mailing Address - Fax:502-895-1261
Practice Address - Street 1:3920 DUTCHMANS LN
Practice Address - Street 2:310
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4702
Practice Address - Country:US
Practice Address - Phone:502-895-1489
Practice Address - Fax:502-895-1261
Is Sole Proprietor?:No
Enumeration Date:2015-11-30
Last Update Date:2019-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1124958363LF0000X
KY3009948363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100377140Medicaid
KY7100377140Medicaid