Basic Information
| Provider Information | |||||||||
| NPI: | 1003153347 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WARD | ||||||||
| FirstName: | PORSCHA | ||||||||
| MiddleName: | DYANNE | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1300 W JEFFERSON ST | ||||||||
| Address2: | SUITE C | ||||||||
| City: | FRANKLIN | ||||||||
| State: | IN | ||||||||
| PostalCode: | 461319121 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3177368474 | ||||||||
| FaxNumber: | 3177366040 | ||||||||
| Practice Location | |||||||||
| Address1: | 1300 W JEFFERSON ST | ||||||||
| Address2: | SUITE C | ||||||||
| City: | FRANKLIN | ||||||||
| State: | IN | ||||||||
| PostalCode: | 461319121 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3177368474 | ||||||||
| FaxNumber: | 3177366040 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/07/2013 | ||||||||
| LastUpdateDate: | 10/21/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 71004279A | IN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 201148550 | 05 | IN | MEDICAID |