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General NPI Number Information
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NPI Number | 1851763650
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Entity Type | Individual
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Provider Name | KEELIN ELIZABETH COVACHA PA-C
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Gender | Female
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Dates
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Enumeration Date | 10/20/2015
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Last Update Date | 09/11/2018
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Provider Practice Location Address
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Address Line | 2178 MENDON RD
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City | CUMBERLAND
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State | RI
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Zip | 02864-3805
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Country | US
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Telephone | 401-333-5201
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Fax |
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Provider Business Mailing Address
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Address Line | 200 HEROUX BLVD UNIT 1606
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City | CUMBERLAND
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State | RI
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Zip | 02864-2388
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Country | US
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Telephone | 203-829-8504
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 3454
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License Number State | CT
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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 | PA00922
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License Number State | RI
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