Provider Demographics
NPI:1881095560
Name:COVINGTON HEALTHCARE LLC
Entity type:Organization
Organization Name:COVINGTON HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS CONSULTANT
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:GWINN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-303-5892
Mailing Address - Street 1:1608-A GILMER AVE
Mailing Address - Street 2:
Mailing Address - City:TALLASSEE
Mailing Address - State:AL
Mailing Address - Zip Code:36078-2314
Mailing Address - Country:US
Mailing Address - Phone:334-782-5028
Mailing Address - Fax:334-782-5028
Practice Address - Street 1:1608-A GILMER AVE
Practice Address - Street 2:
Practice Address - City:TALLASSEE
Practice Address - State:AL
Practice Address - Zip Code:36078-2314
Practice Address - Country:US
Practice Address - Phone:334-782-5028
Practice Address - Fax:334-782-5028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-12
Last Update Date:2023-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-049268363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1-049268OtherCRNP