Provider Demographics
NPI:1437419835
Name:COVINGTON, TARA B (CRNA)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:B
Last Name:COVINGTON
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Gender:F
Credentials:CRNA
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Mailing Address - Street 1:PO BOX 1123
Mailing Address - Street 2:255 WEST MICHIGAN AVENUE
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49204-1123
Mailing Address - Country:US
Mailing Address - Phone:517-787-6440
Mailing Address - Fax:517-787-4146
Practice Address - Street 1:3510 N CAUSEWAY BLVD
Practice Address - Street 2:SUITE 404
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70002-3531
Practice Address - Country:US
Practice Address - Phone:504-779-5515
Practice Address - Fax:504-779-5568
Is Sole Proprietor?:No
Enumeration Date:2012-05-21
Last Update Date:2014-12-03
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Provider Licenses
StateLicense IDTaxonomies
LARN116360367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered