Basic Information
| Provider Information | |||||||||
| NPI: | 1588683767 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LOPES | ||||||||
| FirstName: | KIM | ||||||||
| MiddleName: | D | ||||||||
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| Credential: | CNM | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 12860 | ||||||||
| Address2: | |||||||||
| City: | BELFAST | ||||||||
| State: | ME | ||||||||
| PostalCode: | 049154019 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9193340152 | ||||||||
| FaxNumber: | 9193340132 | ||||||||
| Practice Location | |||||||||
| Address1: | 120 CONNER DR STE 101 | ||||||||
| Address2: | |||||||||
| City: | CHAPEL HILL | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275147092 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9199428571 | ||||||||
| FaxNumber: | 9199426355 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/19/2006 | ||||||||
| LastUpdateDate: | 06/27/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/27/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367A00000X | 526 | NC | Y | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife |
ID Information
| ID | Type | State | Issuer | Description | 7102326000 | 05 | WV | MEDICAID | 7735482 | 01 | WV | AETNA | OTHER | 001721076 | 01 | WV | MS BCBS | OTHER |