Provider Demographics
NPI:1295882215
Name:PORITZ, KIMBERLY JEAN (FNP BC)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:JEAN
Last Name:PORITZ
Suffix:
Gender:F
Credentials:FNP BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2138 N JOSEY LN
Mailing Address - Street 2:SUITE 102
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75006-3034
Mailing Address - Country:US
Mailing Address - Phone:214-350-9334
Mailing Address - Fax:
Practice Address - Street 1:2138 N JOSEY LN
Practice Address - Street 2:SUITE 102
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75006-3034
Practice Address - Country:US
Practice Address - Phone:214-350-9334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2015-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX507150363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX148392701OtherTPI
TX148392701OtherTPI