Provider Demographics
NPI:1588744791
Name:POPP, KAREN (NP)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:POPP
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 LYNN RD STE 205
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360-8040
Mailing Address - Country:US
Mailing Address - Phone:805-497-3585
Mailing Address - Fax:805-497-1313
Practice Address - Street 1:2100 LYNN RD STE 205
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-8040
Practice Address - Country:US
Practice Address - Phone:805-497-3585
Practice Address - Fax:805-497-1313
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA515438163W00000X
CA12019163WA2000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No163WA2000XNursing Service ProvidersRegistered NurseAdministrator
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A440630OtherMEDICAL
CA00A440630OtherMEDICAL
CAB49433Medicare UPIN
CA77-0333869OtherTIN