Provider Demographics
NPI:1376647057
Name:COVINGTON, MITZI (LPN)
Entity Type:Individual
Prefix:
First Name:MITZI
Middle Name:
Last Name:COVINGTON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:MITZI
Other - Middle Name:LOUISE
Other - Last Name:INSCORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 9054
Mailing Address - Street 2:
Mailing Address - City:GRAY
Mailing Address - State:TN
Mailing Address - Zip Code:37615-9054
Mailing Address - Country:US
Mailing Address - Phone:423-467-3600
Mailing Address - Fax:423-467-3696
Practice Address - Street 1:401 HOLSTON DR
Practice Address - Street 2:NOLACKUCKEY MENTAL HEALTH CENTER
Practice Address - City:GREENEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37743
Practice Address - Country:US
Practice Address - Phone:423-639-1104
Practice Address - Fax:423-636-8365
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLPN18635164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse