Phyllis Diane Porter

Primary specialty

Developmentally Disabled Services Day Training AgencyTaxonomy code 251C00000X

License

000809200 Issued in FL

Practice address

6650 103Rd St
Apt 401
Jacksonville, FL 32210-7143

Phone

(904) 559-5434

NPI assigned

Mar 16, 2017

Last updated

Mar 16, 2017By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• In Search of a New Beginning, Inc

  • Home Health Aide
  • Orange Park, FL
  • NPI 1841062783
  NPD Authorized official

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

{
    "created_epoch": "1489622400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1489622400000",
    "number": "1952842528",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7064",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322380064",
            "telephone_number": "904-444-3045"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6650 103RD ST",
            "address_2": "APT 401",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322107143",
            "telephone_number": "904-559-5434"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PORTER",
        "first_name": "PHYLLIS",
        "middle_name": "DIANE",
        "name_prefix": "Miss",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-03-16",
        "last_updated": "2017-03-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "251C00000X",
            "taxonomy_group": "",
            "desc": "Day Training, Developmentally Disabled Services",
            "state": "FL",
            "license": "000809200",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000809200",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Burgess Devone Porter II
• Candace Porter, LCSW
• Irivelisse Stevens Porter, DMD
• Ivan Porter, MD
• Misty D Porter, B.A.
• Shimol Porter
• Steven Porter, MD
• Tekia J Porter
• Porter's Adult Care Inc,
• Porter's Ault Care

• Developmentally Disabled Services Day Training Agency in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Developmentally Disabled Services Day Training Agency in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 2017; 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.