Provider Demographics
NPI:1891552758
Name:PORTER, LAURA AGNES (FNP-C)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:AGNES
Last Name:PORTER
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 749495
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-9495
Mailing Address - Country:US
Mailing Address - Phone:855-963-2100
Mailing Address - Fax:813-321-1296
Practice Address - Street 1:17053 S OUTER RD.
Practice Address - Street 2:1ST FLOOR
Practice Address - City:BELTON
Practice Address - State:MO
Practice Address - Zip Code:64012-2185
Practice Address - Country:US
Practice Address - Phone:816-974-5050
Practice Address - Fax:816-388-9369
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-06
Last Update Date:2025-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-82966-101363LF0000X
MO2024008620363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty