MEDICARE: MRS. ANDREA LAKOLE POPE NP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	1-109035	AL

General Provider Information

NPI Number	:	1083265383
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ANDREA LAKOLE POPE NP-C

Provider Business Mailing Address
First Line	:	1505 E 4TH AVE
Second Line	:
City	:	YORK
State	:	AL
Zip	:	36925-2940
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1505 E 4TH AVE
Second Line	:
City	:	YORK
State	:	AL
Zip	:	36925-2940
Country	:	US
Telephone Number	:	205-343-7300
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/27/2019
Last Update Date	:	01/15/2020

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