Healthcare Provider Details

I. General information

NPI: 1932646825
Provider Name (Legal Business Name): RENEE DAWN KOVAL DNP, RN, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2017
Last Update Date: 06/27/2026
Certification Date: 06/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1224 KANNAPOLIS PL
LEXINGTON KY
40513-1243
US

IV. Provider business mailing address

1224 KANNAPOLIS PL
LEXINGTON KY
40513-1243
US

V. Phone/Fax

Practice location:
  • Phone: 843-906-6107
  • Fax:
Mailing address:
  • Phone: 843-906-6107
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number1214312
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberSP017097
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number4053511
License Number StateKY
# 4
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberF403437-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: