Provider Demographics
NPI:1245268374
Name:KOVAL, VALARIE L (PA-C)
Entity type:Individual
Prefix:
First Name:VALARIE
Middle Name:L
Last Name:KOVAL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1333 W 5TH ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:SHERIDAN
Mailing Address - State:WY
Mailing Address - Zip Code:82801-2752
Mailing Address - Country:US
Mailing Address - Phone:307-672-8921
Mailing Address - Fax:307-672-3944
Practice Address - Street 1:1333 W 5TH ST
Practice Address - Street 2:STE 206
Practice Address - City:SHERIDAN
Practice Address - State:WY
Practice Address - Zip Code:82801
Practice Address - Country:US
Practice Address - Phone:307-673-8383
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYWY 357363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY122418200Medicaid
WY313957OtherBLUE CROSS
WY122418200Medicaid
WYW20600Medicare PIN
WYP00266725Medicare PIN