Provider Demographics
NPI:1659336709
Name:KOVARIK, LINDA M (PA)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:M
Last Name:KOVARIK
Suffix:
Gender:F
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:PO BOX 906
Mailing Address - Street 2:
Mailing Address - City:BURWELL
Mailing Address - State:NE
Mailing Address - Zip Code:68823-0906
Mailing Address - Country:US
Mailing Address - Phone:308-346-5544
Mailing Address - Fax:308-346-4744
Practice Address - Street 1:410 S 8TH
Practice Address - Street 2:
Practice Address - City:BURWELL
Practice Address - State:NE
Practice Address - Zip Code:68823-0906
Practice Address - Country:US
Practice Address - Phone:308-346-5544
Practice Address - Fax:308-346-4744
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE437363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47083890820Medicaid
NE47084643200Medicaid
NE37308OtherBLUE CROSS BLUE SHIELD
NE47083890800Medicaid
NEP47934Medicare UPIN
NE099142Medicare ID - Type Unspecified
NE47083890820Medicaid
NE283836Medicare ID - Type UnspecifiedRIVERBEND-RURAL HEALTH