Individual
KIRK PORTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.-C.
Contact information
Practice address
1107 E MATTHEWS AVE, SUITE 200, JONESBORO, AR 72401-4315
(870) 931-4442
(870) 802-0205
Mailing address
1107 E MATTHEWS AVE, SUITE 200, JONESBORO, AR 72401-4315
(870) 931-4442
(870) 802-0205
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PT2016-011
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
212903795
—
AR
Enumeration date
02/12/2016
Last updated
11/09/2016
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