Provider Demographics
NPI:1417480070
Name:POPE, KIM (BA)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:
Last Name:POPE
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:WY
Mailing Address - Zip Code:82834-1723
Mailing Address - Country:US
Mailing Address - Phone:307-684-2446
Mailing Address - Fax:
Practice Address - Street 1:224 N MAIN ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:WY
Practice Address - Zip Code:82834-1723
Practice Address - Country:US
Practice Address - Phone:307-684-2446
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-10
Last Update Date:2017-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management