Basic Information
| Provider Information | |||||||||
| NPI: | 1326219536 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | COVINGTON | ||||||||
| FirstName: | BRIAN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5000 HOPYARD ROAD | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | PLEASANTON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945883146 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9252516926 | ||||||||
| FaxNumber: | 9259240506 | ||||||||
| Practice Location | |||||||||
| Address1: | 914 S. SCHEUBER ROAD | ||||||||
| Address2: | |||||||||
| City: | CENTRALIA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 985319027 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3607362803 | ||||||||
| FaxNumber: | 5594593719 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/14/2008 | ||||||||
| LastUpdateDate: | 04/26/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AS0400X | PA19442 | CA | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical | 363A00000X | PA60262298 | WA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | 2009431 | 05 | WA | MEDICAID | PENDING | 05 | CA | MEDICAID |