Healthcare Provider Details

I. General information

NPI: 1134084247
Provider Name (Legal Business Name): COVENANT ANESTHESIA MANAGEMENT PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2025
Last Update Date: 12/20/2025
Certification Date: 12/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

149 W STATE HIGHWAY 121 STE 105
COPPELL TX
75019-2933
US

IV. Provider business mailing address

621 DEERWOOD LN
KELLER TX
76248-8481
US

V. Phone/Fax

Practice location:
  • Phone: 972-833-7246
  • Fax:
Mailing address:
  • Phone: 972-522-0098
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MALIA STEPHENSON
Title or Position: PRESIDENT
Credential: CRNA
Phone: 972-533-0098