Healthcare Provider Details

I. General information

NPI: 1659247401
Provider Name (Legal Business Name): AMANDA COVALESKI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2025
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2630 FREDERICA ST
OWENSBORO KY
42301-5440
US

IV. Provider business mailing address

2630 FREDERICA ST
OWENSBORO KY
42301-5440
US

V. Phone/Fax

Practice location:
  • Phone: 270-926-4977
  • Fax:
Mailing address:
  • Phone: 270-926-4977
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number025867
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: