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General NPI Number Information
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NPI Number | 1487907952
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Entity Type | Individual
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Provider Name | KARRA PORTER AYMOND MPAS, P.A.-C
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Gender | Female
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Dates
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Enumeration Date | 10/22/2012
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Last Update Date | 07/31/2014
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Provider Practice Location Address
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Address Line | 2700 HOSPITAL DR
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City | NORTHPORT
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State | AL
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Zip | 35476-3360
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Country | US
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Telephone | 337-208-2243
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Fax |
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Provider Business Mailing Address
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Address Line | 3740 64TH ST NE
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City | TUSCALOOSA
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State | AL
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Zip | 35406-1410
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Country | US
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Telephone | 337-208-2243
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 200573
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License Number State | LA
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