=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285905638
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COVINGTON EXPRESS MEDICAL SERVICES, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/17/2012
-----------------------------------------------------
Last Update Date | 10/21/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1510 W CAUSEWAY APPROACH STE B
-----------------------------------------------------
City | MANDEVILLE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70471-3022
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 985-892-3360
-----------------------------------------------------
Fax | 985-892-3375
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1510 W CAUSEWAY APPROACH STE B
-----------------------------------------------------
City | MANDEVILLE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70471-3022
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 985-892-3360
-----------------------------------------------------
Fax | 985-892-3375
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MELISSA DWORAK
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 985-892-3360
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 016750
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------