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General NPI Number Information
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NPI Number | 1770701609
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Entity Type | Individual
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Provider Name | JEFFREY ARNOLD KOVNICK M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/24/2007
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Last Update Date | 03/19/2025
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Provider Practice Location Address
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Address Line | PO BOX 6106
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City | KETCHUM
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State | ID
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Zip | 83340-6106
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Country | US
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Telephone | 801-910-5822
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 6106
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City | KETCHUM
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State | ID
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Zip | 83340-6106
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Country | US
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Telephone | 801-910-5822
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | 184995-1205
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License Number State | UT
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Taxonomy #2
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | M-17191
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License Number State | ID
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