Provider Demographics
NPI:1164551156
Name:COVINGTON, KIMBERLY J (APRN, CRNA)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:J
Last Name:COVINGTON
Suffix:
Gender:F
Credentials:APRN, CRNA
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:J
Other - Last Name:WEST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN, CRNA
Mailing Address - Street 1:PO BOX 636961
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-6961
Mailing Address - Country:US
Mailing Address - Phone:513-981-5130
Mailing Address - Fax:513-981-5015
Practice Address - Street 1:225 MEDICAL CENTER DR
Practice Address - Street 2:SUITE 105
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42003-7914
Practice Address - Country:US
Practice Address - Phone:270-441-4500
Practice Address - Fax:270-441-4289
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2015-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3002549367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYP01099559OtherRAIL ROAD MEDICARE
KY000000359108OtherKY BCBS IND
KY74483249Medicaid
KY000000543460OtherBC KY
KY000000359108OtherKY BCBS IND
KY000000543460OtherBC KY
KYP01099559OtherRAIL ROAD MEDICARE