Provider Demographics
NPI:1720613920
Name:THORPE, KOVETTE
Entity Type:Individual
Prefix:
First Name:KOVETTE
Middle Name:
Last Name:THORPE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 223
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12602-0223
Mailing Address - Country:US
Mailing Address - Phone:845-763-8504
Mailing Address - Fax:
Practice Address - Street 1:22 MONTGOMERY ST APT 10D
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601-4021
Practice Address - Country:US
Practice Address - Phone:845-763-8504
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-08
Last Update Date:2020-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY616022083OtherDRIVERS LICENSE