Basic Information
| Provider Information | |||||||||
| NPI: | 1023092046 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KOVACS | ||||||||
| FirstName: | KLARA | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | CNM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2866 1ST AVE | ||||||||
| Address2: | SUITE 501 | ||||||||
| City: | HUNTINGTON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 257021200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3046972035 | ||||||||
| FaxNumber: | 3045231485 | ||||||||
| Practice Location | |||||||||
| Address1: | 2866 1ST AVE | ||||||||
| Address2: | SUITE 501 | ||||||||
| City: | HUNTINGTON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 257021200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3046972035 | ||||||||
| FaxNumber: | 3045231485 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/02/2005 | ||||||||
| LastUpdateDate: | 10/09/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367A00000X | 102 | WV | Y | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife |
ID Information
| ID | Type | State | Issuer | Description | 0160173000 | 05 | WV | MEDICAID |