MR. RYAN TODD PORTER (NPI# 1669556213) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1669556213 |
| Entity Type | Individual |
| Full Name | MR. RYAN TODD PORTER |
| Credential | PA-C |
| Practice Address |
98 Poplar St Blackfoot ID 83221-1758 |
| Practice Telephone | 2087854100 |
| Mailing Telephone | 2087854100 |
| Enumeration Date | 2006-10-24 |
| Last Update Date | 2009-12-30 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AS0400X |
Physician Assistant Specialization: Surgical Technologist |
PA-827 | ID | Physician Assistants & Advanced Practice Nursing Providers |
| N | 363AS0400X |
Physician Assistant Specialization: Surgical Technologist |
447 | MT | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| ID | 808517600 | 05 | |
| MT | 4307719 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1811184955 | Ryan Troy Porter | Counselor | 5221 Fredrick Ct, A, Gurnee, IL 60031-6064 | 2007-10-03 |
| 1336579432 | Ryan K. Porter | Social Worker | 1217 1st St Nw, Albuquerque, NM 87102-1529 | 2013-11-26 |
| 1700225257 | Ryan Claiborne Porter | Internal Medicine | 5959 Park Ave, Memphis, TN 38119-5200 | 2013-06-18 |
| 1235387218 | Ryan Gary Porter | Obstetrics & Gynecology | 1501 N Campbell Ave, Obstetrics and Gynecology, Tucson, AZ 85724-0001 | 2008-09-03 |
| 1912160441 | Ryan G Porter Sr. | Otolaryngology | 611 W. Park St., Sc2, Urbana, IL 61801-2500 | 2008-07-03 |
| 1578725651 | Ryan F Porter | Internal Medicine | 1200 John Q Hammons Dr, Madison, WI 53717-1959 | 2008-06-30 |
| 1083763668 | Ryan Joseph Porter | Dentist | 3592 S Atherton Blvd, #112, Gilbert, AZ 85297-7443 | 2007-01-10 |
| Street Address |
98 POPLAR ST |
| City | BLACKFOOT |
| State | ID |
| Zip Code | 83221-1758 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609871474 | Wade H Flowers Jr. | Pharmacist | 98 Poplar St, Blackfoot, ID 83221-1758 | 2005-06-16 |
| 1629685177 | Lucus Craig Webb Christoffersen | Registered Nurse | 98 Poplar St, Blackfoot, ID 83221-1799 | 2020-09-29 |
| 1770111924 | Kywnynn Madsen | Dietitian, Registered | 98 Poplar St, Blackfoot, ID 83221-1758 | 2020-03-31 |
| 1235795915 | Megan Lewis | Advanced Practice Midwife | 98 Poplar St, Blackfoot, ID 83221-1758 | 2019-05-17 |
| 1083177935 | Jason Lee Harmon | Student in an Organized Health Care Education/Training Program | 98 Poplar St, Blackfoot, ID 83221-1758 | 2019-04-08 |
| 1851870091 | Jennifer L Wistisen | Physician Assistant | 98 Poplar St, Blackfoot, ID 83221-1799 | 2018-08-08 |
| 1114405396 | Ryan Blair Killpack | Physician Assistant | 98 Poplar St, Blackfoot, ID 83221-1758 | 2018-07-31 |
| 1023504651 | Amanda Wray | Pharmacist | 98 Poplar St, Blackfoot, ID 83221-1758 | 2018-07-06 |
| 1699268276 | Zachary D Morrow | Nurse Anesthetist, Certified Registered | 98 Poplar St, Blackfoot, ID 83221-1758 | 2018-06-08 |
| 1184115107 | Megan Nicole Broyles | Pharmacist | 98 Poplar St, Blackfoot, ID 83221 | 2018-05-24 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932711165 | Samantha Paige Averett | Social Worker | 60 N Broadway, Blackfoot, ID 83221 | 2020-08-19 |
| 1730711656 | Sara Marie Letham | Family Medicine | 33 S Thompson Lane, Blackfoot, ID 83221 | 2020-02-08 |
| 1962994962 | Tyler Thomas Wood | Student in an Organized Health Care Education/Training Program | 98 Poplar Street, Blackfoot, Id 83221, Blackfoot, ID 83221 | 2018-06-05 |
| 1801336276 | Bmh, Inc. | Internal Medicine | 235 Poplar St, Blackfoot, ID 83221 | 2017-03-03 |
| 1497119804 | Susan Doran | Social Worker | 720 E. Alice, Blackfoot, ID 83221 | 2016-04-12 |
| 1427412121 | Josie Russell Adkins | Counselor | 720 East Alice, Blackfoot, ID 83221 | 2016-04-08 |
| 1740590314 | Ashley Nichole Thomas | Physician Assistant | 710 E. Alice Street, Blackfoot, ID 83221 | 2010-10-18 |
| 1528373313 | Stephanie Lynn Henderson | Dietitian, Registered | 1555 Vernon Ave, Blackfoot, ID 83221 | 2010-08-17 |
| 1184850141 | Joy H. Taylor | Nurse Practitioner | 1441 Parkway Drive, Blackfoot, ID 83221 | 2009-06-04 |
| 1427232925 | Nathan E. Sneddon | Anesthesiology | 98 Poplar St Fl 3, Blackfoot, ID 83221 | 2007-12-20 |
| Find all providers in zip 83221 | ||||
| Taxonomy Code | 363AS0400X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Surgical Technologist |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003874389 | Beverly Hanson | Physician Assistant | 98 Poplar St, Blackfoot, ID 83221-1758 | 2006-05-03 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881218089 | Michael Keegan Huntsman | Physician Assistant | 730 Aspen Ave, Shelley, ID 83274-1400 | 2020-06-03 |
| 1700447141 | Katie Elizabeth Nichols | Physician Assistant | 1072 N Liberty St Ste 201, Boise, ID 83704 | 2019-06-26 |
| 1831647197 | Nicholas Hensley | Physician Assistant | 3155 Channing Way Ste B, Idaho Falls, ID 83404-7534 | 2016-09-15 |
| 1811369549 | Anna Stoia | Physician Assistant | 4401 E. Tuscany Ave., Nampa, ID 83686 | 2015-10-21 |
| 1982937066 | Don H Curtis | Physician Assistant | 348 W Bloomington Dr, Meridian, ID 83642-6942 | 2009-09-08 |
| 1801073655 | Tracy D. Mickelsen | Physician Assistant | 3015 E Magic View Dr, Meridian, ID 83642-3743 | 2008-01-23 |
| 1356437172 | Clare Elizabeth York | Physician Assistant | 805 Main St., Salmon, ID 83467 | 2006-10-05 |
| 1891707618 | Brian Keith Lachapelle | Physician Assistant | 6140 W Curtisan, Ste 102, Boise, ID 83704 | 2006-08-12 |
| 1992743215 | Bill Stahlberg | Physician Assistant | 211 Forest St, Mccall, ID 83638-5256 | 2006-06-02 |
| 1780641530 | Alicia R Borst | Physician Assistant | 3960 W. Wainwright, Boise, ID 83713 | 2006-04-26 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.