Active NPI
Peggy J Porter, FNP
- Family Nurse Practitioner
- Kealakekua, HI
National Provider Identifier
1497881742
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- 440373
- Practice address
- 81-6587 Mamalahoa Hwy
C 201
Kealakekua, HI 96750 - Phone
- (808) 323-3107
- Fax
- (808) 323-0012
- NPI assigned
- Feb 23, 2007
- Last updated
- Aug 30, 2016
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 440373 | TX | Primary |
Addresses
Primary practice location
81-6587 Mamalahoa Hwy
C 201
Kealakekua, HI 96750
Mailing address
816587 Mamalahoa Hwy
Kealakekua, HI 96750
Phone (808) 323-3107
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 150022505 | Medicaid | TX | |
| 150022506 | Medicaid | TX | |
| 150022507 | Medicaid | TX |
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 |
|---|---|---|---|
| 440373 | TX | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Grapevine Emergency Physicians PLLC | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Emergency Medicine Physician
- Grapevine, TX
- NPI 1770650483
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1172188800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1472515200000",
"number": "1497881742",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "816587 MAMALAHOA HWY",
"city": "KEALAKEKUA",
"state": "HI",
"postal_code": "96750",
"telephone_number": "808-323-3107",
"fax_number": "808-323-0012"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "81-6587 MAMALAHOA HWY",
"address_2": "C 201",
"city": "KEALAKEKUA",
"state": "HI",
"postal_code": "96750",
"telephone_number": "808-323-3107",
"fax_number": "808-323-0012"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PORTER",
"first_name": "PEGGY",
"middle_name": "J",
"credential": "FNP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-02-23",
"last_updated": "2016-08-30",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "TX",
"license": "440373",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "150022505",
"state": "TX"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "150022506",
"state": "TX"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "150022507",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Kealakekua, HI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.