Provider Demographics
NPI:1295359743
Name:COVINGTON, MICHAEL JACOB (DO)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:JACOB
Last Name:COVINGTON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3907 CREEKSIDE LOOP STE 100
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902-4879
Mailing Address - Country:US
Mailing Address - Phone:509-895-7535
Mailing Address - Fax:509-895-7355
Practice Address - Street 1:3907 CREEKSIDE LOOP STE 100
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-4879
Practice Address - Country:US
Practice Address - Phone:509-895-7535
Practice Address - Fax:509-895-7355
Is Sole Proprietor?:No
Enumeration Date:2020-06-01
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP61278492207Q00000X
WAOL61064723390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2160223Medicaid