Provider Demographics
NPI:1013013796
Name:POPE, KELLY A (APRN)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:A
Last Name:POPE
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Gender:F
Credentials:APRN
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Mailing Address - Street 1:PO BOX 776347
Mailing Address - Street 2:DEPT 86156
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6347
Mailing Address - Country:US
Mailing Address - Phone:502-588-9490
Mailing Address - Fax:502-272-5116
Practice Address - Street 1:2355 POPLAR LEVEL RD
Practice Address - Street 2:STE 405
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40217-1395
Practice Address - Country:US
Practice Address - Phone:502-636-7845
Practice Address - Fax:502-636-8045
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2021-11-17
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Provider Licenses
StateLicense IDTaxonomies
KY3002616363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100027650Medicaid