Provider Demographics
NPI:1033401088
Name:STIDHAM, COVA TERESA (APRN)
Entity Type:Individual
Prefix:
First Name:COVA
Middle Name:TERESA
Last Name:STIDHAM
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1895 ELIZABETHTOWN RD.
Mailing Address - Street 2:
Mailing Address - City:LEITCHFIELD
Mailing Address - State:KY
Mailing Address - Zip Code:42754-9138
Mailing Address - Country:US
Mailing Address - Phone:270-230-0182
Mailing Address - Fax:270-230-0014
Practice Address - Street 1:1895 ELIZABETHTOWN RD.
Practice Address - Street 2:
Practice Address - City:LEITCHFIELD
Practice Address - State:KY
Practice Address - Zip Code:42754-9138
Practice Address - Country:US
Practice Address - Phone:270-230-0182
Practice Address - Fax:270-230-0014
Is Sole Proprietor?:No
Enumeration Date:2011-05-10
Last Update Date:2011-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3006909363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYK000831Medicare PIN