Healthcare Provider Details

I. General information

NPI: 1932039096
Provider Name (Legal Business Name): EMILY CAROL KOVIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2026
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date: 05/26/2026
Reactivation Date: 07/17/2026

III. Provider practice location address

19320 E ADMIRAL PL STE B
CATOOSA OK
74015-3240
US

IV. Provider business mailing address

608 N YELLOWOOD AVE
BROKEN ARROW OK
74012-0604
US

V. Phone/Fax

Practice location:
  • Phone: 918-340-5503
  • Fax:
Mailing address:
  • Phone: 918-533-6637
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License NumberM084301127
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: