Provider Demographics
NPI:1194366195
Name:KOVOLSKI, CARRIE L (FNP-C)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:L
Last Name:KOVOLSKI
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:CARRIE
Other - Middle Name:LYNN
Other - Last Name:KOVOLSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CARRIE BISHOP RN
Mailing Address - Street 1:801 ROSEHILL RD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49202-1762
Mailing Address - Country:US
Mailing Address - Phone:989-731-2145
Mailing Address - Fax:517-212-2009
Practice Address - Street 1:4760 FASHION SQUARE BLVD STE L-1
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48604-2620
Practice Address - Country:US
Practice Address - Phone:989-282-4003
Practice Address - Fax:888-491-7220
Is Sole Proprietor?:No
Enumeration Date:2019-10-01
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704197129363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily