Provider Demographics
NPI:1649275769
Name:POPE, ERIN E (PAC)
Entity type:Individual
Prefix:MRS
First Name:ERIN
Middle Name:E
Last Name:POPE
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:ELIZABETH
Other - Last Name:SCHWEISS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PAC
Mailing Address - Street 1:2200 E PARRISH AVE
Mailing Address - Street 2:BLDG D SUITE 100
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303-1449
Mailing Address - Country:US
Mailing Address - Phone:270-688-1770
Mailing Address - Fax:270-688-1781
Practice Address - Street 1:2200 E PARRISH AVE
Practice Address - Street 2:BLDG D SUITE 100
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-1449
Practice Address - Country:US
Practice Address - Phone:270-688-1770
Practice Address - Fax:270-688-1781
Is Sole Proprietor?:No
Enumeration Date:2005-06-15
Last Update Date:2013-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPA863363A00000X
IN10000755A363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000343849OtherANTHEM
KY0649916Medicare PIN
Q24549Medicare UPIN
KYP00327428Medicare PIN
000000343849OtherANTHEM