WANDERFUL PORTER FNP-BC NPI 1407833221

NPI Information

  • NPI: 1407833221
  • Provider Name: WANDERFUL PORTER, FNP-BC
  • Classification: Nurse Practitioner - 363LP2300X
  • Specialization: Primary Care
  • Entity Type: Individual
  • PECOS Registration: Yes
  • Address: 602 BRUNSON DR
    TUPELO, MS
    ZIP 38801
  • Phone: (662) 680-3855

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NPI Details

Wanderful Porter, FNP-BC is a primary care nurse practitioner in Tupelo, MS. Wanderful Porter, FNP-BC NPI is 1407833221. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

602 BRUNSON DR
TUPELO, MS
ZIP 38801-947
Phone: (662) 680-3855
Fax: (662) 680-3372

The NPI 1407833221 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 12/22/2005 and was last updated on 10/30/2024.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1363LP2300XNurse PractitionerPrimary CareR748355MISSISSIPPIYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
100124068MEDICAIDMISSISSIPPI

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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