Provider Demographics
NPI:1255309886
Name:KOVALCHIK, BARBARA (ARNP RN)
Entity Type:Individual
Prefix:MRS
First Name:BARBARA
Middle Name:
Last Name:KOVALCHIK
Suffix:
Gender:F
Credentials:ARNP RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 NEW GLENDALE RD
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-1023
Mailing Address - Country:US
Mailing Address - Phone:270-769-1601
Mailing Address - Fax:270-765-7274
Practice Address - Street 1:108 NEW GLENDALE RD
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-1023
Practice Address - Country:US
Practice Address - Phone:270-769-1601
Practice Address - Fax:270-765-7274
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2010-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1052071163W00000X
KY3048P363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
S98314Medicare UPIN