Individual
KIMBERLY ANN PAULINE PORTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1400 W STATE ST STE C, WEST LAFAYETTE, IN 47906-3438
(765) 494-0111
Mailing address
2007 SAW MILL RD, LAFAYETTE, IN 47905-5559
(904) 652-4725
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
28224750A
IN
Other
Enumeration date
08/24/2017
Last updated
08/24/2017
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