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General NPI Number Information
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NPI Number | 1598908337
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Entity Type | Individual
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Provider Name | KIMBERLY R. POARCH PA-C
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Gender | Female
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Dates
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Enumeration Date | 04/09/2009
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Last Update Date | 08/02/2011
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Provider Practice Location Address
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Address Line | 10100 N CENTRAL EXPY STE.100
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City | DALLAS
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State | TX
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Zip | 75231-4159
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Country | US
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Telephone | 214-373-7374
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Fax | 214-373-7003
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Provider Business Mailing Address
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Address Line | 10100 N CENTRAL EXPY STE.100
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City | DALLAS
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State | TX
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Zip | 75231-4159
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Country | US
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Telephone | 214-373-7374
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Fax | 214-373-7003
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA03154
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License Number State | TX
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