Healthcare Provider Details

I. General information

NPI: 1841118353
Provider Name (Legal Business Name): MATOYA KAMILLAH COVINGTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2026
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8135 CALUMET AVE
MUNSTER IN
46321-1701
US

IV. Provider business mailing address

3723 217TH ST
MATTESON IL
60443-3704
US

V. Phone/Fax

Practice location:
  • Phone: 219-922-2535
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209035322
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: