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General NPI Number Information
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NPI Number | 1588370563
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Entity Type | Individual
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Provider Name | KIMBERLY PORTER
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Gender | Female
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Dates
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Enumeration Date | 01/24/2023
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Last Update Date | 09/02/2026
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Provider Practice Location Address
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Address Line | 626 EASTMAN RD STE B
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City | CENTER CONWAY
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State | NH
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Zip | 03813-4219
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Country | US
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Telephone | 603-447-2111
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Fax | 603-447-1021
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Provider Business Mailing Address
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Address Line | 626 EASTMAN RD STE A
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City | CENTER CONWAY
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State | NH
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Zip | 03813-4219
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Country | US
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Telephone | 603-447-3347
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Fax | 603-447-8893
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 043805-21
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License Number State | NH
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 043805-23
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License Number State | NH
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