Provider Demographics
NPI:1528769932
Name:PORTER, SHELLIE REIGH (LPN)
Entity type:Individual
Prefix:
First Name:SHELLIE
Middle Name:REIGH
Last Name:PORTER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1410 E IRON AVE
Mailing Address - Street 2:
Mailing Address - City:SALINA
Mailing Address - State:KS
Mailing Address - Zip Code:67401-3284
Mailing Address - Country:US
Mailing Address - Phone:316-685-2221
Mailing Address - Fax:316-469-0807
Practice Address - Street 1:1410 E IRON AVE
Practice Address - Street 2:
Practice Address - City:SALINA
Practice Address - State:KS
Practice Address - Zip Code:67401-3284
Practice Address - Country:US
Practice Address - Phone:316-685-2221
Practice Address - Fax:316-469-0807
Is Sole Proprietor?:No
Enumeration Date:2023-03-13
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS47519164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse