Individual
CHRISTA J KOVACHEVICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ARNP, CPNP-PC
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
43135
WY
363LP0200X
Pediatric Nurse Practitioner
9390419
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
016218600
—
FL
Enumeration date
10/23/2015
Last updated
08/08/2019
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