Provider Demographics
NPI:1518040476
Name:THORPE, KRISTEAN PORTER (MD)
Entity Type:Individual
Prefix:DR
First Name:KRISTEAN
Middle Name:PORTER
Last Name:THORPE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KRISTEAN
Other - Middle Name:ANN
Other - Last Name:PORTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 6210
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87499-6210
Mailing Address - Country:US
Mailing Address - Phone:505-609-2258
Mailing Address - Fax:505-325-3054
Practice Address - Street 1:610 W. PINON ST.
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87401
Practice Address - Country:US
Practice Address - Phone:505-325-1123
Practice Address - Fax:505-325-3054
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2010-0196207V00000X
FLTRN10143207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMMD2010-0196OtherMEDICAL BOARD