Provider Demographics
NPI:1134762750
Name:COVINGTON, JESSICA AUDREY (NP)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:AUDREY
Last Name:COVINGTON
Suffix:
Gender:F
Credentials:NP
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Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:5282 GOLDEN ISLE W
Mailing Address - Street 2:
Mailing Address - City:BAXLEY
Mailing Address - State:GA
Mailing Address - Zip Code:31513-7999
Mailing Address - Country:US
Mailing Address - Phone:912-347-6065
Mailing Address - Fax:
Practice Address - Street 1:204 E 15TH ST
Practice Address - Street 2:
Practice Address - City:ALMA
Practice Address - State:GA
Practice Address - Zip Code:31510-2908
Practice Address - Country:US
Practice Address - Phone:912-632-2952
Practice Address - Fax:912-632-8682
Is Sole Proprietor?:No
Enumeration Date:2019-10-27
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GARN205926363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA0034264451AMedicaid