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General NPI Number Information
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NPI Number | 1801368907
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Entity Type | Individual
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Provider Name | ADRIENNE RENE KOVACIK PA-C
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Gender | Female
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Dates
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Enumeration Date | 12/30/2018
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Last Update Date | 03/30/2021
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Provider Practice Location Address
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Address Line | 101 MANNING DR
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City | CHAPEL HILL
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State | NC
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Zip | 27514-4220
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Country | US
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Telephone | 919-974-1000
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Fax |
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Provider Business Mailing Address
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Address Line | 500 GARENDON DR
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City | CARY
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State | NC
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Zip | 27519-6315
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Country | US
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Telephone | 919-931-9585
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number |
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 0010-08775
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License Number State | NC
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