1598795767 NPI number — MS. KATHRYN MAE KOVAR

Table of content: MS. KATHRYN MAE KOVAR (NPI 1598795767)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598795767 NPI number — MS. KATHRYN MAE KOVAR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KOVAR
Provider First Name:
KATHRYN
Provider Middle Name:
MAE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KOVAR
Provider Other First Name:
KATY
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
CRNA
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1598795767
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/03/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
108 REDSTONE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BISMARCK
Provider Business Mailing Address State Name:
ND
Provider Business Mailing Address Postal Code:
58503-1463
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
701-222-0753
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
108 REDSTONE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BISMARCK
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58503-1463
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-222-0753
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/04/2006

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:  R25020 , registered in the state of ND ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: P00398986 . This is a "RR MEDICARE GROUP CQ2302" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 145396 . This is a "BCBS KS GROUP 110017" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 200420090A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".