Basic Information
Provider Information
NPI: 1699309260
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: COVEY
FirstName: KRISTIN
MiddleName: D
NamePrefix:  
NameSuffix:  
Credential: CNM, DNP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 25608
Address2:  
City: SALT LAKE CITY
State: UT
PostalCode: 841250608
CountryCode: US
TelephoneNumber: 2063204476
FaxNumber: 2065687043
Practice Location
Address1: 1101 MADISON ST
Address2: STE 700
City: SEATTLE
State: WA
PostalCode: 981043599
CountryCode: US
TelephoneNumber: 2065438736
FaxNumber:  
Other Information
ProviderEnumerationDate: 02/23/2020
LastUpdateDate: 11/05/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 11/05/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
163W00000XRN60763789WAN Nursing Service ProvidersRegistered Nurse 
367A00000XAP61065970WAY Physician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife 

No ID Information.


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