Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 3002616 | KY |
NPI | 1013013796 |
---|---|
Provider Name | Mrs. Kelly A Pope |
First Address | Chicago, IL 60677-6347 |
Second Address | Louisville, KY 40217-1395 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/09/2006 |
Last Update Date | 17/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7100027650 | (05) | KY |