Healthcare Provider Details

I. General information

NPI: 1518752674
Provider Name (Legal Business Name): HALEY KOVACH PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2025
Last Update Date: 04/10/2025
Certification Date: 04/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5308 HARROUN RD STE 280
SYLVANIA OH
43560-2190
US

IV. Provider business mailing address

5308 HARROUN RD STE 280
SYLVANIA OH
43560-2190
US

V. Phone/Fax

Practice location:
  • Phone: 419-824-5668
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50.008795RX
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: