Provider Demographics
NPI:1710688072
Name:KOVACHEVICH, COURTNEY (PMHNP)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:
Last Name:KOVACHEVICH
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5700 MEXICO RD STE 8
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63376-1667
Mailing Address - Country:US
Mailing Address - Phone:636-477-6464
Mailing Address - Fax:
Practice Address - Street 1:5700 MEXICO RD STE 8
Practice Address - Street 2:
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-1667
Practice Address - Country:US
Practice Address - Phone:636-477-6464
Practice Address - Fax:636-410-9291
Is Sole Proprietor?:No
Enumeration Date:2023-03-14
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2023013503363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily