Individual provider Active NPI

Kierstin Porter, DO

  • Surgery Physician
  • Des Moines, IA
National Provider Identifier
1063300911
Registry record updated Jul 7, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
R-13991 Issued in IA
Practice address
1111 6TH Ave
Des Moines, IA 50314-2613
Phone
(515) 643-2261
Fax
(515) 643-5802
NPI assigned
Jun 26, 2025
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 7, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 2025025412 MO
Surgery Physician 208600000X R-13991 IA Primary

Addresses

Primary practice location

1111 6TH Ave
Des Moines, IA 50314-2613

Mailing address

1111 6TH Ave
Des Moines, IA 50314-2613
Phone (515) 643-2261

Other practice location 1

1 Hospital Dr
Columbia, MO 65212-1000
Phone (573) 884-0762

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250729001200 MO Order and Referring Only - General SurgeryPractitioner - General Surgery 8426565003

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
2025025412MOMDSurgery Physician

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1750896000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783382400000",
    "number": "1063300911",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1111 6TH AVE",
            "city": "DES MOINES",
            "state": "IA",
            "postal_code": "503142613",
            "telephone_number": "515-643-2261",
            "fax_number": "515-643-5802"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1111 6TH AVE",
            "city": "DES MOINES",
            "state": "IA",
            "postal_code": "503142613",
            "telephone_number": "515-643-2261",
            "fax_number": "515-643-5802"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1 Hospital Dr",
            "address_purpose": "LOCATION",
            "city": "Columbia",
            "state": "MO",
            "postal_code": "652121000",
            "country_code": "US",
            "telephone_number": "573-884-0762",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PORTER",
        "first_name": "KIERSTIN",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-06-26",
        "last_updated": "2026-07-07",
        "certification_date": "2026-07-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "MO",
            "license": "2025025412",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "IA",
            "license": "R-13991",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Des Moines, IA

Sources for this page

Verify at the official NPI Registry.