Provider Demographics
NPI:1598908337
Name:POARCH, KIMBERLY R (PA-C)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:R
Last Name:POARCH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10100 N CENTRAL EXPY
Mailing Address - Street 2:STE.100
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-4159
Mailing Address - Country:US
Mailing Address - Phone:214-373-7374
Mailing Address - Fax:214-373-7003
Practice Address - Street 1:10100 N CENTRAL EXPY
Practice Address - Street 2:STE.100
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-4159
Practice Address - Country:US
Practice Address - Phone:214-373-7374
Practice Address - Fax:214-373-7003
Is Sole Proprietor?:No
Enumeration Date:2009-04-09
Last Update Date:2011-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA03154363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPA03154OtherPHYSICIAN ASSISTANT LICENSE TEXAS MEDICAL BOARD