Provider Demographics
NPI:1285001123
Name:COVINGTON, ANITRA
Entity Type:Individual
Prefix:MRS
First Name:ANITRA
Middle Name:
Last Name:COVINGTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1503 LEE ST
Mailing Address - Street 2:
Mailing Address - City:FRANKLINTON
Mailing Address - State:LA
Mailing Address - Zip Code:70438-2021
Mailing Address - Country:US
Mailing Address - Phone:985-295-4400
Mailing Address - Fax:985-923-0285
Practice Address - Street 1:1503 LEE ST
Practice Address - Street 2:
Practice Address - City:FRANKLINTON
Practice Address - State:LA
Practice Address - Zip Code:70438-2021
Practice Address - Country:US
Practice Address - Phone:985-295-4400
Practice Address - Fax:985-923-0285
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-26
Last Update Date:2015-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA453840001343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2190792Medicaid