Individual
ALIA PORTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1306 STATE ST, AUGUSTA, KS 67010-1126
(316) 617-4275
Mailing address
1306 STATE ST, AUGUSTA, KS 67010-1126
(316) 775-9191
(316) 775-0348
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
15-02389
KS
363AM0700X
Medical Physician Assistant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30004717980001
—
KS
Enumeration date
05/28/2020
Last updated
10/27/2022
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