Provider Demographics
NPI:1992524144
Name:PORTER, KATEY GIBSON (PA-C)
Entity type:Individual
Prefix:
First Name:KATEY
Middle Name:GIBSON
Last Name:PORTER
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6890 W ANDREW JOHNSON HWY
Mailing Address - Street 2:
Mailing Address - City:TALBOTT
Mailing Address - State:TN
Mailing Address - Zip Code:37877-8610
Mailing Address - Country:US
Mailing Address - Phone:423-839-2120
Mailing Address - Fax:
Practice Address - Street 1:3811 NELSON SCHOOL RD
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:TN
Practice Address - Zip Code:37813-4429
Practice Address - Country:US
Practice Address - Phone:423-300-0568
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-05
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6216363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant