Kimberly Jean Porter, PAC

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA.200235 Issued in LA

Practice address

243 Curtiss Rd
Barksdale Afb, LA 71110-2425

Phone

(318) 456-7320

Fax

(318) 456-6246

NPI assigned

Apr 5, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Miss Kimberly Jean Evans Former name

Medicare fee-for-service enrollment

Enrolled in LA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Cross Lake Emergency Group, LLC

  • Emergency Medicine Physician
  • Shreveport, LA
  • NPI 1013497114
  Medicare reassignment
• Texas Trail Emergency Physicians LLC

  • Emergency Medicine Physician
  • Shreveport, LA
  • NPI 1902052301
  NPD (past)

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

{
    "created_epoch": "1144195200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1565913600000",
    "number": "1780646612",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 CORPORATE BLVD",
            "city": "LAFAYETTE",
            "state": "LA",
            "postal_code": "705083870",
            "telephone_number": "800-893-9698"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "243 CURTISS RD",
            "city": "BARKSDALE AFB",
            "state": "LA",
            "postal_code": "711102425",
            "telephone_number": "318-456-7320",
            "fax_number": "318-456-6246"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2510 Bert Kouns Industrial Loop",
            "address_purpose": "LOCATION",
            "city": "Shreveport",
            "state": "LA",
            "postal_code": "711183180",
            "country_code": "US",
            "telephone_number": "318-212-5000",
            "fax_number": "318-632-5217",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2400 Hospital Dr",
            "address_purpose": "LOCATION",
            "city": "Bossier City",
            "state": "LA",
            "postal_code": "711112385",
            "country_code": "US",
            "telephone_number": "318-212-7000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2600 Greenwood Rd",
            "address_purpose": "LOCATION",
            "city": "Shreveport",
            "state": "LA",
            "postal_code": "711033908",
            "country_code": "US",
            "telephone_number": "318-212-4000",
            "fax_number": "318-632-5217",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "8001 Youree Dr",
            "address_purpose": "LOCATION",
            "city": "Shreveport",
            "state": "LA",
            "postal_code": "711152302",
            "country_code": "US",
            "telephone_number": "318-212-3000",
            "fax_number": "318-212-3008",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PORTER",
        "first_name": "KIMBERLY",
        "middle_name": "JEAN",
        "name_prefix": "Mrs.",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-04-05",
        "last_updated": "2019-08-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "LA",
            "license": "PA.200235",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCCPA",
            "identifier": "1070445",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KIMBERLY",
            "last_name": "EVANS",
            "middle_name": "JEAN",
            "prefix": "MISS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Alexandra Okai, D.D.S
• Justin Michael Owens, M.D.
• Flora Park, DO
• Justin Zachary Peoples, DO
• Heather Marie Phinney, IDMT
• Alexander Purring, PSYD
• Melissa Nicole Ratliff
• Ellen Rice, M.D.
• Jeffrey Blaine Robinson, DMD
• Zaimara Rodriguez, MSW

• Physician Assistant in Barksdale Afb, LA
• Providers in Barksdale Afb, LA by specialty
• Physician Assistant in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.