Provider Demographics
NPI:1609619543
Name:PORTER, ALLISON (RMA)
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:
Last Name:PORTER
Suffix:
Gender:F
Credentials:RMA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 TAKOMA AVE STE 207
Mailing Address - Street 2:
Mailing Address - City:GREENEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37743-4647
Mailing Address - Country:US
Mailing Address - Phone:423-798-2053
Mailing Address - Fax:423-798-2054
Practice Address - Street 1:204 N CUTLER ST
Practice Address - Street 2:
Practice Address - City:GREENEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37745-3846
Practice Address - Country:US
Practice Address - Phone:423-798-2053
Practice Address - Fax:423-798-2054
Is Sole Proprietor?:No
Enumeration Date:2024-06-18
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2856170376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide