Provider Demographics
NPI:1376613604
Name:POPE, DONNA MOORE (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:MOORE
Last Name:POPE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 KY HIGHWAY 392
Mailing Address - Street 2:
Mailing Address - City:CYNTHIANA
Mailing Address - State:KY
Mailing Address - Zip Code:41031-8715
Mailing Address - Country:US
Mailing Address - Phone:859-234-3702
Mailing Address - Fax:
Practice Address - Street 1:364 ODDVILLE AVE
Practice Address - Street 2:
Practice Address - City:CYNTHIANA
Practice Address - State:KY
Practice Address - Zip Code:41031-9472
Practice Address - Country:US
Practice Address - Phone:859-234-2842
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1870P363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY8378Medicare ID - Type UnspecifiedCLINIC BILLING NUMBER