Active NPI
James Alan Porter, CRNP-PMH
- Psychiatric/Mental Health Nurse Practitioner
- Nellis Afb, NV
National Provider Identifier
1396306270
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatric/Mental Health Nurse Practitioner
- License
- 95103397
- Practice address
- 4700 Las Vegas Blvd N
Nellis Afb, NV 89191-6600 - Phone
- (702) 653-2273
- NPI assigned
- Jun 22, 2019
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatric/Mental Health Nurse Practitioner | 363LP0808X | 95103397 | CA | Primary |
| Psychiatric/Mental Health Nurse Practitioner | 363LP0808X | 1-149892 | AL | |
| Psychiatric/Mental Health Nurse Practitioner | 363LP0808X | R240364 | MD |
Addresses
Primary practice location
4700 Las Vegas Blvd N
Nellis Afb, NV 89191-6600
Mailing address
4700 Las Vegas Blvd N
Nellis Afb, NV 89191-6600
Phone (702) 653-2273
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 119591300 | Medicaid | MD |
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
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1-149892 | AL | MD | Psychiatric/Mental Health Nurse Practitioner |
| 95103397 | CA | MD | Psychiatric/Mental Health Nurse Practitioner |
| R240364 | MD | MD | Psychiatric/Mental Health Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1561161600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1703116800000",
"number": "1396306270",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4700 LAS VEGAS BLVD N",
"city": "NELLIS AFB",
"state": "NV",
"postal_code": "891916600",
"telephone_number": "702-653-2273"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4700 LAS VEGAS BLVD N",
"city": "NELLIS AFB",
"state": "NV",
"postal_code": "891916600",
"telephone_number": "702-653-2273"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PORTER",
"first_name": "JAMES",
"middle_name": "ALAN",
"name_prefix": "Mr.",
"credential": "CRNP-PMH",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-06-22",
"last_updated": "2023-12-21",
"certification_date": "2023-12-21",
"status": "A"
},
"taxonomies": [
{
"code": "363LP0808X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Psychiatric/Mental Health",
"state": "CA",
"license": "95103397",
"primary": true
},
{
"code": "363LP0808X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Psychiatric/Mental Health",
"state": "AL",
"license": "1-149892",
"primary": false
},
{
"code": "363LP0808X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Psychiatric/Mental Health",
"state": "MD",
"license": "R240364",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "119591300",
"state": "MD"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Nellis Afb, NV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.