Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 71000468A | IN |
NPI | 1013066620 |
---|---|
Provider Name | Kimberly A Kovacich |
First Address | Mccordsville, IN 46055-9566 |
Second Address | Mccordsville, IN 46055-9715 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/01/2007 |
Last Update Date | 18/02/2014 |