Healthcare Provider Details

I. General information

NPI: 1720365331
Provider Name (Legal Business Name): CASSANDRA CHRISTINE PORTER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2011
Last Update Date: 05/27/2025
Certification Date: 05/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3512 S LAFOUNTAIN ST
KOKOMO IN
46902-3803
US

IV. Provider business mailing address

2254 SEASONS SOUTH DR UNIT 1115
CARMEL IN
46280-1664
US

V. Phone/Fax

Practice location:
  • Phone: 657-763-1007
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number363A00000X
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number10001355A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: