Individual provider Active NPI

Tiffany Porter, DNP

  • Family Nurse Practitioner
  • Wichita, KS
National Provider Identifier
1154115129
Registry record updated Apr 7, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
5383978091 Issued in KS
Practice address
3610 E Ross Pkwy
Wichita, KS 67210-1311
Phone
(216) 866-2000
NPI assigned
Apr 7, 2025
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 7, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 5383978091 KS Primary

Addresses

Primary practice location

3610 E Ross Pkwy
Wichita, KS 67210-1311

Mailing address

430 S Dellrose Ave
Wichita, KS 67218-1414
Phone (702) 884-4793

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KS
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250521000868 KS Practitioner - Nurse Practitioner 9638698822 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
5383978091KSMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Gracemed Health Clinic Inc CurrentSince Jun 15, 2025 Accepting new patients
Gracemed Health Clinic, Inc CurrentSince Jun 15, 2025 Accepting new patients

Locations

1122 N Topeka St
Wichita, KS 67214
Phone (316) 263-7455

1150 N Broadway Ave
Wichita, KS 67214

3610 E Ross Pkwy
Wichita, KS 67210
Phone (216) 866-2000

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1743984000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1743984000000",
    "number": "1154115129",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "430 S DELLROSE AVE",
            "city": "WICHITA",
            "state": "KS",
            "postal_code": "672181414",
            "telephone_number": "702-884-4793"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3610 E ROSS PKWY",
            "city": "WICHITA",
            "state": "KS",
            "postal_code": "672101311",
            "telephone_number": "216-866-2000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PORTER",
        "first_name": "TIFFANY",
        "credential": "DNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-04-07",
        "last_updated": "2025-04-07",
        "certification_date": "2025-04-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "KS",
            "license": "5383978091",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wichita, KS

Sources for this page

Verify at the official NPI Registry.