Provider Demographics
NPI:1225620891
Name:KOVACH, KRISTEN (FNP-C, RN)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:KOVACH
Suffix:
Gender:F
Credentials:FNP-C, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1605 N MARTHA CT
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-7358
Mailing Address - Country:US
Mailing Address - Phone:312-420-7929
Mailing Address - Fax:
Practice Address - Street 1:1124 NEW HIGHWAY 52 E
Practice Address - Street 2:
Practice Address - City:WESTMORELAND
Practice Address - State:TN
Practice Address - Zip Code:37186-5032
Practice Address - Country:US
Practice Address - Phone:615-644-2000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-05
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN248563163WG0000X
TN30282363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice