Nicholas Porta, PSYD

Primary specialty

PsychologistTaxonomy code 103T00000X

License

P0000003473 Issued in TN

Practice address

2514 1/2 Wesley St Ste 2
Johnson City, TN 37601-1754

Phone

(423) 529-0385

Fax

(423) 414-2699

NPI assigned

Sep 25, 2015

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1443139200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521590400000",
    "number": "1013387687",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2514 1/2 WESLEY ST STE 2",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376011754",
            "telephone_number": "423-529-0385",
            "fax_number": "423-414-2699"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2514 1/2 WESLEY ST STE 2",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376011754",
            "telephone_number": "423-529-0385",
            "fax_number": "423-414-2699"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PORTA",
        "first_name": "NICHOLAS",
        "name_prefix": "Dr.",
        "credential": "PSYD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-09-25",
        "last_updated": "2018-03-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "MO",
            "license": "2015033025",
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "TN",
            "license": "P0000003473",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rebekah Polofsky
• Edward L Pomerantz, LCSW
• Emily Madisyn Pompeo, DO
• Melanie Teresa Pope
• Marcela Popescu, M.D.
• Lewis Gordon Porter IV, PA-C
• Lea Ann Poteat, PHARM. D.
• Robin Hager Potter, LMSW
• Mehdi Pourmorteza, D.O.
• Allen R Powell, PA-C

• Psychologist in Johnson City, TN
• Providers in Johnson City, TN by specialty
• Psychologist in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 21, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.