Provider Demographics
NPI:1154831642
Name:PORTER, DAVID VAUGHN JR (PA-C)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:VAUGHN
Last Name:PORTER
Suffix:JR
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7450 KESSLER ST STE 202
Mailing Address - Street 2:
Mailing Address - City:MERRIAM
Mailing Address - State:KS
Mailing Address - Zip Code:66204-2553
Mailing Address - Country:US
Mailing Address - Phone:913-632-9480
Mailing Address - Fax:913-632-9499
Practice Address - Street 1:7450 KESSLER ST STE 202
Practice Address - Street 2:
Practice Address - City:MERRIAM
Practice Address - State:KS
Practice Address - Zip Code:66204-2553
Practice Address - Country:US
Practice Address - Phone:913-632-9480
Practice Address - Fax:913-632-9499
Is Sole Proprietor?:No
Enumeration Date:2017-10-10
Last Update Date:2025-07-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2017036354363AM0700X
KS15-03060363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical