Basic Information
| Provider Information | |||||||||
| NPI: | 1558379230 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PORTER | ||||||||
| FirstName: | KRIS | ||||||||
| MiddleName: | D | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 94 BLUFF VW | ||||||||
| Address2: | |||||||||
| City: | ALEDO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 760084580 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5128003187 | ||||||||
| FaxNumber: | 8558139308 | ||||||||
| Practice Location | |||||||||
| Address1: | 251 WESTPARK WAY STE 210 | ||||||||
| Address2: | |||||||||
| City: | EULESS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 760403742 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5128003187 | ||||||||
| FaxNumber: | 8558139308 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/04/2006 | ||||||||
| LastUpdateDate: | 05/02/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/02/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | J8509 | TX | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 102517308 | 05 | TX | MEDICAID | 102517304 | 05 | TX | MEDICAID | 102517305 | 05 | TX | MEDICAID |