Provider Demographics
NPI:1003898453
Name:COVILLO, JEAN M
Entity Type:Individual
Prefix:MS
First Name:JEAN
Middle Name:M
Last Name:COVILLO
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:JEAN
Other - Middle Name:M
Other - Last Name:STIMPFEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN ARNP CRNA
Mailing Address - Street 1:1701 S 45TH ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66106-2527
Mailing Address - Country:US
Mailing Address - Phone:913-721-3641
Mailing Address - Fax:913-721-3649
Practice Address - Street 1:1701 S 45TH ST
Practice Address - Street 2:SUITE A
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66106-2527
Practice Address - Country:US
Practice Address - Phone:913-721-3641
Practice Address - Fax:913-721-3649
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-18
Last Update Date:2015-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO108523163W00000X, 367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO66048A005OtherWPS TRICARE
MOP00369535OtherRAILROAD MEDICARE
MO918614223Medicaid
MO25266032OtherBCBS OF KANSAS CITY
KS145350OtherBLUE CROSS BLUE SHIELD KANSAS
KS10770OtherPREFERRED HEALTH SYSTEMS
KSP00395162OtherRAILROAD MEDICARE
KS406B00014OtherMEDICARE PTAN
KS10001514701OtherCOMMUNITY HEALTH PLAN
KS100254420EMedicaid
KS145350Medicare PIN
MOW494243Medicare PIN
MO406A00021Medicare PIN
KS10770OtherPREFERRED HEALTH SYSTEMS
MOP00369535OtherRAILROAD MEDICARE
KS406B00014OtherMEDICARE PTAN
MO918614223Medicaid
MOW494243AMedicare PIN