Provider Demographics
NPI:1609107648
Name:COVEY, DONNA CAROLE (DNP, FNP, AGACNP)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:CAROLE
Last Name:COVEY
Suffix:
Gender:F
Credentials:DNP, FNP, AGACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10361 FM 1377
Mailing Address - Street 2:
Mailing Address - City:BLUE RIDGE
Mailing Address - State:TX
Mailing Address - Zip Code:75424-4141
Mailing Address - Country:US
Mailing Address - Phone:903-271-6658
Mailing Address - Fax:
Practice Address - Street 1:609 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:TX
Practice Address - Zip Code:76234-3836
Practice Address - Country:US
Practice Address - Phone:940-627-5921
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-14
Last Update Date:2019-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP118768363LA2100X, 363LG0600X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX#8379NUOtherBCBSTX - WHS-PS
TXPENDING - WHS-PSMedicaid
TX213881004Medicaid
TX213881004Medicaid
TXTXB124512Medicare PIN