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Organization

PONY EXPRESS PEDIATRICS, LLC

Active
Parent organization
PONY EXPRESS PEDIATRICS, LLC
Organization subpart
Yes

Provider details

NPI number
Legal business name
PONY EXPRESS PEDIATRICS, LLC
Authorized official
CHRISTA JAYLEEN KOVACHEVICH APRN (OWNER/APRN CPNP-PC)
(321) 313-3595
Entity
Organization

Contact information

Practice address
1307 CROOK AVE, CHEYENNE, WY 82001-5412
(321) 313-3595
Mailing address
2076 PAINTED SKY RD, CHEYENNE, WY 82009-9196
(321) 313-3595

Taxonomy

Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
016218600
FL
Enumeration date
08/08/2019
Last updated
08/08/2019
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