Individual
KIMBERLY DIANE POPE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
BHRS
Contact information
Practice address
729 LEHIGH AVE, HARTSHORNE, OK 74547-3627
(918) 429-2851
Mailing address
729 LEHIGH AVE, HARTSHORNE, OK 74547-3627
(918) 429-2851
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100746580A
—
OK
Enumeration date
01/26/2010
Last updated
01/26/2010
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