Provider Demographics
NPI:1215344650
Name:POPE, KATEE ELIZABETH (PA)
Entity type:Individual
Prefix:
First Name:KATEE
Middle Name:ELIZABETH
Last Name:POPE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:KATEE
Other - Middle Name:
Other - Last Name:HOGOBOOM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:577 MICHIGAN AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49423-4911
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:577 MICHIGAN AVE STE 202
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49423-4911
Practice Address - Country:US
Practice Address - Phone:616-494-5810
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-17
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601007060363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant