=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104551076
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | EMILY COVENEY
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/23/2022
-----------------------------------------------------
Last Update Date | 08/30/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 20 THE LEGENDS PKWY
-----------------------------------------------------
City | EUREKA
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63025-3823
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 636-938-3399
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 776084
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60677-1105
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 636-938-3399
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------