Provider Demographics
NPI:1730302191
Name:COVINGTON, CALLIE COURTNEY (PA-C)
Entity type:Individual
Prefix:
First Name:CALLIE
Middle Name:COURTNEY
Last Name:COVINGTON
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1211 UNION AVE STE 330
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38104-6655
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1325 EASTMORELAND AVE STE 101
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-3507
Practice Address - Country:US
Practice Address - Phone:901-261-3500
Practice Address - Fax:901-624-2961
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2025-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPA00089363A00000X
TN2120363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS512I970013OtherMEDICARE PROVIDER TRANSACTION ACCESSUE NUMBER