Provider Demographics
NPI:1720017908
Name:POPE, KRISTEN WINONA (MD)
Entity Type:Individual
Prefix:DR
First Name:KRISTEN
Middle Name:WINONA
Last Name:POPE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:KRISTEN
Other - Middle Name:
Other - Last Name:LEM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 411851
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64141-1851
Mailing Address - Country:US
Mailing Address - Phone:913-588-6805
Mailing Address - Fax:913-588-7899
Practice Address - Street 1:3901 RAINBOW BLVD
Practice Address - Street 2:MS 4032
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66160-7234
Practice Address - Country:US
Practice Address - Phone:913-588-6805
Practice Address - Fax:913-588-7899
Is Sole Proprietor?:No
Enumeration Date:2006-07-01
Last Update Date:2014-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009009832174400000X
MO04-30728174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS323B00001Medicare PIN
MO323A00001Medicare PIN