Active NPI
Brenda Diane Porco-Smith, ARNP
- Family Nurse Practitioner
- Kennewick, WA
National Provider Identifier
1104993179
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- AP60194888
- Practice address
- 6710 W Okanogan Place
Kennewick, WA 99336 - Phone
- (509) 783-2000
- Fax
- (509) 783-2008
- NPI assigned
- Nov 29, 2006
- Last updated
- Jul 6, 2015
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Nurse Specialist | 364S00000X | 352639 | CA | |
| Family Nurse Practitioner | 363LF0000X | AP60194888 | WA | Primary |
Addresses
Primary practice location
6710 W Okanogan Place
Kennewick, WA 99336
Mailing address
560 Gage Blvd
Suite 203
Richland, WA 99352
Phone (509) 942-3627
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104993179 | Medicaid | WA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| AP60194888 | WA | MD | Family Nurse Practitioner |
| 352639 | CA | MD | Clinical Nurse Specialist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Our Lady of Lourdes Health Center | Past | Accepting new patients | |
| Kadlec Regional Medical Center | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- General Acute Care Hospital
- Richland, WA
- NPI 1972507580
-
dba Lourdes Urology East
- Urology Physician
- Pasco, WA
- NPI 1649785569
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1164758400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1436140800000",
"number": "1104993179",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "560 GAGE BLVD",
"address_2": "SUITE 203",
"city": "RICHLAND",
"state": "WA",
"postal_code": "99352",
"telephone_number": "509-942-3627",
"fax_number": "509-942-2268"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6710 W OKANOGAN PLACE",
"city": "KENNEWICK",
"state": "WA",
"postal_code": "99336",
"telephone_number": "509-783-2000",
"fax_number": "509-783-2008"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PORCO-SMITH",
"first_name": "BRENDA",
"middle_name": "DIANE",
"credential": "ARNP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-11-29",
"last_updated": "2015-07-06",
"status": "A"
},
"taxonomies": [
{
"code": "364S00000X",
"taxonomy_group": "",
"desc": "Clinical Nurse Specialist",
"state": "CA",
"license": "352639",
"primary": false
},
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "WA",
"license": "AP60194888",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1104993179",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Kennewick, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 6, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.