Healthcare Provider Details

I. General information

NPI: 1174009187
Provider Name (Legal Business Name): STEPHANIE KOVACS RD, LDN, CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2018
Last Update Date: 07/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1215 21ST AVE S FL 8
NASHVILLE TN
37232-0014
US

IV. Provider business mailing address

1037 KEYSTONE DR
PLEASANT VIEW TN
37146-7000
US

V. Phone/Fax

Practice location:
  • Phone: 931-241-1945
  • Fax:
Mailing address:
  • Phone: 931-241-1945
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: