Healthcare Provider Details

I. General information

NPI: 1932455342
Provider Name (Legal Business Name): JESSICA MORIAH COVERT ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JESSICA MORIAH VANDERVEEN ATC

II. Dates (important events)

Enumeration Date: 08/03/2012
Last Update Date: 01/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3575 KEITH ST NW STE 205
CLEVELAND TN
37312-4324
US

IV. Provider business mailing address

1200 CORPORATE DR STE 400
BIRMINGHAM AL
35242-5424
US

V. Phone/Fax

Practice location:
  • Phone: 423-559-0444
  • Fax: 423-559-0103
Mailing address:
  • Phone: 423-238-7217
  • Fax: 423-238-3473

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT002093
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number1550
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: