Provider Demographics
NPI:1457717647
Name:POPE, KATHERINE MARY
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:MARY
Last Name:POPE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2039 FOREST AVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-4817
Mailing Address - Country:US
Mailing Address - Phone:408-947-2929
Mailing Address - Fax:408-283-7720
Practice Address - Street 1:2030 FOREST AVE
Practice Address - Street 2:SUITE 110
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-4833
Practice Address - Country:US
Practice Address - Phone:408-947-2929
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-05
Last Update Date:2016-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95002459363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily