Provider Demographics
NPI:1831622836
Name:KOVAC, MAGAN THIBODAUX (WHNP-BC, APRN)
Entity type:Individual
Prefix:
First Name:MAGAN
Middle Name:THIBODAUX
Last Name:KOVAC
Suffix:
Gender:F
Credentials:WHNP-BC, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2205 OLD JEANERETTE RD
Mailing Address - Street 2:
Mailing Address - City:NEW IBERIA
Mailing Address - State:LA
Mailing Address - Zip Code:70563-8687
Mailing Address - Country:US
Mailing Address - Phone:337-367-9411
Mailing Address - Fax:
Practice Address - Street 1:2205 OLD JEANERETTE RD
Practice Address - Street 2:
Practice Address - City:NEW IBERIA
Practice Address - State:LA
Practice Address - Zip Code:70563-8687
Practice Address - Country:US
Practice Address - Phone:337-367-9411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-06
Last Update Date:2017-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP09268363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health