MEDICARE: SUSAN SPENCER COVINGTON PMHNP

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	0024195504	VA

General Provider Information

NPI Number	:	1861354797
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN SPENCER COVINGTON PMHNP

Provider Business Mailing Address
First Line	:	200 MEDICAL PARK BLVD
Second Line	:
City	:	PETERSBURG
State	:	VA
Zip	:	23805-9274
Country	:	US
Telephone Number	:	804-467-8719
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 MEDICAL PARK BLVD
Second Line	:
City	:	PETERSBURG
State	:	VA
Zip	:	23805-9274
Country	:	US
Telephone Number	:	804-467-8719
Fax Number	:

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

Provider Enumeration Date	:	12/01/2025
Last Update Date	:	12/01/2025

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