Provider Demographics
NPI:1073956900
Name:KOVAL, CHRISTINE NICOLE (PA-C)
Entity Type:Individual
Prefix:MS
First Name:CHRISTINE
Middle Name:NICOLE
Last Name:KOVAL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:724 AUBREY BELL DR
Mailing Address - Street 2:
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28105-5055
Mailing Address - Country:US
Mailing Address - Phone:704-295-3550
Mailing Address - Fax:704-295-3556
Practice Address - Street 1:724 AUBREY BELL DR
Practice Address - Street 2:
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-5055
Practice Address - Country:US
Practice Address - Phone:704-295-3550
Practice Address - Fax:704-295-3556
Is Sole Proprietor?:No
Enumeration Date:2013-04-10
Last Update Date:2017-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA6727363AM0700X
VA0110005070363AM0700X
NC0010-06969363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC19NLAOtherBCBSNC
5277888OtherAETNA
SC2830PAMedicaid
NC19NLAOtherBCBSNC