Provider Demographics
NPI:1134853658
Name:COVINGTON, DAVONTAE (NP)
Entity type:Individual
Prefix:
First Name:DAVONTAE
Middle Name:
Last Name:COVINGTON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:DAVONTAE
Other - Middle Name:
Other - Last Name:ABRAHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:700 WALNUT ST FL 2
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19106-3505
Mailing Address - Country:US
Mailing Address - Phone:215-503-4779
Mailing Address - Fax:
Practice Address - Street 1:700 WALNUT ST FL 2
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19106-3505
Practice Address - Country:US
Practice Address - Phone:215-503-4779
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-11
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP025893363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily