MEDICARE: KATRINA KOVARIK-STEVENS CPNP

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	363L00000X	Nurse Practitioner	079152	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	109211	OTHER		BLUE CROSS OF MO
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1558462895
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATRINA KOVARIK-STEVENS CPNP

Provider Business Mailing Address
First Line	:	PO BOX 4046
Second Line	:
City	:	SPRINGFIELD
State	:	MO
Zip	:	65808-4046
Country	:	US
Telephone Number	:	417-269-5712
Fax Number	:	417-269-7567

Provider Business Practice Location Address
First Line	:	1741 S 15TH ST
Second Line	:
City	:	OZARK
State	:	MO
Zip	:	65721-9030
Country	:	US
Telephone Number	:	417-730-5550
Fax Number	:	417-730-5555

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

Provider Enumeration Date	:	09/26/2006
Last Update Date	:	07/21/2022

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