Provider Demographics
NPI:1184065955
Name:COVINGTON, KENYATTA
Entity type:Individual
Prefix:MR
First Name:KENYATTA
Middle Name:
Last Name:COVINGTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15406 LEXINGTON AVE
Mailing Address - Street 2:SUITE 9
Mailing Address - City:HARVEY
Mailing Address - State:IL
Mailing Address - Zip Code:60426-3611
Mailing Address - Country:US
Mailing Address - Phone:708-825-1016
Mailing Address - Fax:708-825-1413
Practice Address - Street 1:15406 LEXINGTON AVE
Practice Address - Street 2:SUITE 9
Practice Address - City:HARVEY
Practice Address - State:IL
Practice Address - Zip Code:60426-3611
Practice Address - Country:US
Practice Address - Phone:708-825-1016
Practice Address - Fax:708-825-1413
Is Sole Proprietor?:No
Enumeration Date:2013-07-09
Last Update Date:2013-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy