MEDICARE: KATHLEEN KAY COVENTRY MS CCCA FAAA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	231H00000X	Audiologist	51403	TX

General Provider Information

NPI Number	:	1518907476
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHLEEN KAY COVENTRY MS CCCA FAAA

Provider Business Mailing Address
First Line	:	5959 GATEWAY WEST
Second Line	:	STE 120
City	:	EL PASO
State	:	TX
Zip	:	79925-3315
Country	:	US
Telephone Number	:	915-779-1716
Fax Number	:	915-771-6558

Provider Business Practice Location Address
First Line	:	5959 GATEWAY WEST
Second Line	:	STE 160
City	:	EL PASO
State	:	TX
Zip	:	79925-3315
Country	:	US
Telephone Number	:	915-779-5866
Fax Number	:	915-771-6558

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/08/2006
Last Update Date	:	07/08/2007

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