Provider Demographics
NPI:1336862440
Name:COVINGTON, SALLY JO ANNA (AGACNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:SALLY JO
Middle Name:ANNA
Last Name:COVINGTON
Suffix:
Gender:F
Credentials:AGACNP-BC
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Mailing Address - Street 1:2101 HIGHWAY 90
Mailing Address - Street 2:
Mailing Address - City:GAUTIER
Mailing Address - State:MS
Mailing Address - Zip Code:39553-5340
Mailing Address - Country:US
Mailing Address - Phone:228-497-7576
Mailing Address - Fax:
Practice Address - Street 1:3101 DENNY AVE STE 210
Practice Address - Street 2:
Practice Address - City:PASCAGOULA
Practice Address - State:MS
Practice Address - Zip Code:39581-5307
Practice Address - Country:US
Practice Address - Phone:228-809-5355
Practice Address - Fax:228-202-3458
Is Sole Proprietor?:No
Enumeration Date:2022-09-22
Last Update Date:2023-01-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MS905473363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner