Provider Demographics
NPI:1598795767
Name:KOVAR, KATHRYN MAE
Entity Type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:MAE
Last Name:KOVAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KATY
Other - Middle Name:
Other - Last Name:KOVAR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CRNA
Mailing Address - Street 1:108 REDSTONE DR
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58503-1463
Mailing Address - Country:US
Mailing Address - Phone:701-222-0753
Mailing Address - Fax:
Practice Address - Street 1:108 REDSTONE DR
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58503-1463
Practice Address - Country:US
Practice Address - Phone:701-222-0753
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2009-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR25020367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSP00398986OtherRR MEDICARE GROUP CQ2302
KS145396OtherBCBS KS GROUP 110017
KS200420090AMedicaid
KSP00398986OtherRR MEDICARE GROUP CQ2302