Basic Information
| Provider Information | |||||||||
| NPI: | 1609227289 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PORTER | ||||||||
| FirstName: | KIMBERLY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5302 IAN DR | ||||||||
| Address2: | |||||||||
| City: | MC LEANSVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 273018123 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3363270278 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2511 OLD CORNWALLIS RD | ||||||||
| Address2: | |||||||||
| City: | DURHAM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 277131869 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9199483983 | ||||||||
| FaxNumber: | 9199336881 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/25/2016 | ||||||||
| LastUpdateDate: | 08/31/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 5008757 | NC | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.