Provider Demographics
NPI:1902118979
Name:KOVAL, OLGA V (FNP)
Entity Type:Individual
Prefix:
First Name:OLGA
Middle Name:V
Last Name:KOVAL
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:OLGA
Other - Middle Name:V
Other - Last Name:PAVLYUKOVETS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:PO BOX 743070
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-3070
Mailing Address - Country:US
Mailing Address - Phone:864-560-4304
Mailing Address - Fax:864-560-4413
Practice Address - Street 1:101 E WOOD ST
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29303-3040
Practice Address - Country:US
Practice Address - Phone:864-560-6012
Practice Address - Fax:864-560-6013
Is Sole Proprietor?:No
Enumeration Date:2010-07-07
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC23398363LF0000X
NY336329363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCSCG5965019OtherMEDICARE PIN
SCNP6368Medicaid