Mallorie Porter, RN, IBCLC

Primary specialty

Lactation Consultant (Registered Nurse)Taxonomy code 163WL0100X

License

L-306361 Issued in NC

Practice address

522 Potts St
Davidson, NC 28036-8406

Phone

(704) 997-9406

Fax

(704) 896-4907

NPI assigned

Jul 5, 2022

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 2

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Nurse

State licenses

Practice roles

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.

• Lake Norman Breastfeeding Solutions LLC

  • Lactation Consultant (Non-RN)
  • Davidson, NC
  • NPI 1770029001
  NPD

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

{
    "created_epoch": "1656979200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1656979200000",
    "number": "1174256473",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "522 POTTS ST",
            "city": "DAVIDSON",
            "state": "NC",
            "postal_code": "280368406",
            "telephone_number": "704-997-9406",
            "fax_number": "704-896-4907"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "522 POTTS ST",
            "city": "DAVIDSON",
            "state": "NC",
            "postal_code": "280368406",
            "telephone_number": "704-997-9406",
            "fax_number": "704-896-4907"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PORTER",
        "first_name": "MALLORIE",
        "credential": "RN, IBCLC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-07-05",
        "last_updated": "2022-07-05",
        "certification_date": "2022-07-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "NC",
            "license": "255956",
            "primary": false
        },
        {
            "code": "163WL0100X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Lactation Consultant",
            "state": "NC",
            "license": "L-306361",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RN",
            "identifier": "255956",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IBCLC",
            "identifier": "L-306361",
            "state": "NC"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mallorie@lknbreastfeedingsolutions.com",
            "affiliation": "N",
            "address_1": "522 Potts St",
            "city": "Davidson",
            "state": "NC",
            "country_code": "US",
            "postal_code": "280368406",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Stefanie E. Petyak, MA, LMFT
• Physiofit Physical Therapy and Sports Performance LLC
• Leslie Laughlin Pitt, LMFTA
• Juan Pizarro
• Alexandru Paul Popa, LCMHCA
• Danielle Preziosi, IBCLC
• Gladys Prieto, D.M.D.
• Stephen Profeta, PHARMD
• Michelle Putney
• Marina Lynn Randles, LCMHCA

• Lactation Consultant (Registered Nurse) in Davidson, NC
• Providers in Davidson, NC by specialty
• Lactation Consultant (Registered Nurse) in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 5, 2022; 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.