Healthcare Provider Details

I. General information

NPI: 1558462895
Provider Name (Legal Business Name): KATRINA KOVARIK-STEVENS CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1741 S 15TH ST
OZARK MO
65721-9030
US

IV. Provider business mailing address

PO BOX 4046
SPRINGFIELD MO
65808-4046
US

V. Phone/Fax

Practice location:
  • Phone: 417-730-5550
  • Fax: 417-730-5555
Mailing address:
  • Phone: 417-269-5712
  • Fax: 417-269-7567

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number079152
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: