MEDICARE: KIMBERLY R. POARCH PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	PA03154	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PA03154	OTHER	TX	PHYSICIAN ASSISTANT LICENSE TEXAS MEDICAL BOARD

General Provider Information

NPI Number	:	1598908337
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY R. POARCH PA-C

Provider Business Mailing Address
First Line	:	10100 N CENTRAL EXPY
Second Line	:	STE.100
City	:	DALLAS
State	:	TX
Zip	:	75231-4159
Country	:	US
Telephone Number	:	214-373-7374
Fax Number	:	214-373-7003

Provider Business Practice Location Address
First Line	:	10100 N CENTRAL EXPY
Second Line	:	STE.100
City	:	DALLAS
State	:	TX
Zip	:	75231-4159
Country	:	US
Telephone Number	:	214-373-7374
Fax Number	:	214-373-7003

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/09/2009
Last Update Date	:	08/02/2011

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Directions to “ KIMBERLY R. POARCH PA-C” Practice Location

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