Healthcare Provider Details

I. General information

NPI: 1790422384
Provider Name (Legal Business Name): JOEL COVINGTON PMHNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2022
Last Update Date: 05/16/2022
Certification Date: 05/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

361 E 1200 S STE 201
OREM UT
84058-6904
US

IV. Provider business mailing address

361 E 1200 S STE 201
OREM UT
84058-6904
US

V. Phone/Fax

Practice location:
  • Phone: 801-224-3014
  • Fax: 801-224-4914
Mailing address:
  • Phone: 801-224-3014
  • Fax: 801-224-4914

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number8428619-4405
License Number StateUT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: