Provider Demographics
NPI:1184480519
Name:POPE, MICHELLE MARTINEZ (MSN, APRN-CNS, AGCNS)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:MARTINEZ
Last Name:POPE
Suffix:
Gender:F
Credentials:MSN, APRN-CNS, AGCNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5119 EDEN DR
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73135-4311
Mailing Address - Country:US
Mailing Address - Phone:405-388-4524
Mailing Address - Fax:
Practice Address - Street 1:825 NE 10TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73104-5417
Practice Address - Country:US
Practice Address - Phone:405-271-3635
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-23
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK60166163WA2000X
OK218359364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
No163WA2000XNursing Service ProvidersRegistered NurseAdministrator