| NPI | 1588003354 |
|---|---|
| Former Name | JESSEE TAYLOR PORTER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WI 4361-23) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: IL 085.005796) |
| Enumeration Date | 2013-06-14 |
| Last Update Date | 2021-10-08 |