Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 4662 | KY |
NPI | 1043669914 |
---|---|
Provider Name | Kandi Pope |
First Address | Fort Campbell, KY 42223 |
Second Address | Fort Campbell, KY 42223 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/06/2016 |
Last Update Date | 10/06/2016 |