Healthcare Provider Details

I. General information

NPI: 1326219536
Provider Name (Legal Business Name): BRIAN COVINGTON PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2008
Last Update Date: 04/26/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

914 S. SCHEUBER ROAD
CENTRALIA WA
98531-9027
US

IV. Provider business mailing address

5000 HOPYARD ROAD SUITE 100
PLEASANTON CA
94588-3146
US

V. Phone/Fax

Practice location:
  • Phone: 360-736-2803
  • Fax: 559-459-3719
Mailing address:
  • Phone: 925-251-6926
  • Fax: 925-924-0506

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA19442
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA60262298
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: