Provider Demographics
NPI:1588683767
Name:LOPES, KIM D (CNM)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:D
Last Name:LOPES
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 12860
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-4019
Mailing Address - Country:US
Mailing Address - Phone:919-334-0152
Mailing Address - Fax:919-334-0132
Practice Address - Street 1:120 CONNER DR STE 101
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514-7092
Practice Address - Country:US
Practice Address - Phone:919-942-8571
Practice Address - Fax:919-942-6355
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC526367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV7102326000Medicaid
WV7735482OtherAETNA
WV001721076OtherMS BCBS
WV2031487Medicare PIN
WV2031483Medicare PIN
WV2031486Medicare PIN
WVNM02751Medicare PIN
WVNM02753Medicare PIN
2031484Medicare PIN
WV2031482Medicare PIN
WV001721076OtherMS BCBS
WV7102326000Medicaid
WVNM02752Medicare PIN
WV2031485Medicare PIN