Healthcare Provider Details

I. General information

NPI: 1225920705
Provider Name (Legal Business Name): COVENANT WOUND CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2025
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 S THOMPSON ST
FLAGSTAFF AZ
86001-8759
US

IV. Provider business mailing address

5440 S J DIAMOND RD
FLAGSTAFF AZ
86005-9329
US

V. Phone/Fax

Practice location:
  • Phone: 928-226-6400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL DALE HILBURN
Title or Position: OWNER/PROVIDER
Credential: NP-C
Phone: 806-336-9061