1164551156 NPI number — KIMBERLY J COVINGTON APRN, CRNA

Table of content: KIMBERLY J COVINGTON APRN, CRNA (NPI 1164551156)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164551156 NPI number — KIMBERLY J COVINGTON APRN, CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COVINGTON
Provider First Name:
KIMBERLY
Provider Middle Name:
J
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
APRN, CRNA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WEST
Provider Other First Name:
KIMBERLY
Provider Other Middle Name:
J
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
APRN, CRNA
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1164551156
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/09/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 636961
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CINCINNATI
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45263-6961
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
513-981-5130
Provider Business Mailing Address Fax Number:
513-981-5015

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
225 MEDICAL CENTER DR
Provider Second Line Business Practice Location Address:
SUITE 105
Provider Business Practice Location Address City Name:
PADUCAH
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42003-7914
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-441-4500
Provider Business Practice Location Address Fax Number:
270-441-4289
Provider Enumeration Date:
03/05/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 367500000X , with the licence number:  3002549 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: P01099559 . This is a "RAIL ROAD MEDICARE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 000000359108 . This is a "KY BCBS IND" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 74483249 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000543460 . This is a "BC KY" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".




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