Healthcare Provider Details

I. General information

NPI: 1356651020
Provider Name (Legal Business Name): CHRISTY COOVERT RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHRISTY MATHERLY RN

II. Dates (important events)

Enumeration Date: 10/15/2010
Last Update Date: 03/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 SAINT CHRISTOPHER DR
ASHLAND KY
41101-7020
US

IV. Provider business mailing address

PO BOX 2155
ASHLAND KY
41105-2155
US

V. Phone/Fax

Practice location:
  • Phone: 606-833-6762
  • Fax:
Mailing address:
  • Phone: 606-316-3156
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WX0200X
TaxonomyOncology Registered Nurse
License Number1133885
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code163WX0200X
TaxonomyOncology Registered Nurse
License Number87404
License Number StateWV
# 3
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number6711
License Number StateAK
# 4
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number55898
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: