Provider Demographics
NPI:1083376867
Name:PORTER, KATHERINE ANN (RPH)
Entity Type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:ANN
Last Name:PORTER
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15520 HOWE ST
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66224-3897
Mailing Address - Country:US
Mailing Address - Phone:913-982-6348
Mailing Address - Fax:
Practice Address - Street 1:15520 HOWE ST
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66224-3897
Practice Address - Country:US
Practice Address - Phone:913-982-6348
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-09
Last Update Date:2021-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-14145183500000X, 1835P2201X
MO2006028518183500000X, 1835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care
No183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PARP-032172-LOtherPENNSYLVANIA PHARMACIST LICENSE
KS1-14145OtherKANSAS PHARMACIST LICENSE
MO2006028518OtherMISSOURI PHARMACIST LICENSE