Individual
MRS. AMANDA KIM COVAULT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
2510 LAKELAND DRIVE, BRANDON, MS 39232-9513
(601) 355-1234
(601) 326-3566
Mailing address
2510 LAKELAND DR, BRANDON, MS 39232-9513
(601) 355-1234
(601) 326-3566
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
880864
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
08403082
—
MS
Enumeration date
04/13/2006
Last updated
01/05/2017
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