Provider Demographics
NPI:1326219536
Name:COVINGTON, BRIAN (PA)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:
Last Name:COVINGTON
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5000 HOPYARD ROAD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94588-3146
Mailing Address - Country:US
Mailing Address - Phone:925-251-6926
Mailing Address - Fax:925-924-0506
Practice Address - Street 1:914 S. SCHEUBER ROAD
Practice Address - Street 2:
Practice Address - City:CENTRALIA
Practice Address - State:WA
Practice Address - Zip Code:98531-9027
Practice Address - Country:US
Practice Address - Phone:360-736-2803
Practice Address - Fax:559-459-3719
Is Sole Proprietor?:No
Enumeration Date:2008-03-14
Last Update Date:2017-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA19442363AS0400X
WAPA60262298363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2009431Medicaid
CAPENDINGMedicaid
WA2009431Medicaid
CAPENDINGMedicaid