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Individual
MRS. KIMBERLY JEAN PORTER
Active
Individual
MRS. KIMBERLY JEAN PORTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PAC
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA.200235
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1070445
NCCPA
—
Enumeration date
04/05/2006
Last updated
08/16/2019
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