Healthcare Provider Details

I. General information

NPI: 1821186917
Provider Name (Legal Business Name): MEREDITH H COVINGTON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 08/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 N STATE ST # LL-10
JACKSON MS
39202
US

IV. Provider business mailing address

965 RIDGE LAKE BLVD STE 103
MEMPHIS TN
38120-9446
US

V. Phone/Fax

Practice location:
  • Phone: 601-362-7280
  • Fax: 601-362-8116
Mailing address:
  • Phone: 901-227-3255
  • Fax: 901-428-8311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR870674
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: