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Contact Information

PONY EXPRESS PEDIATRICS, LLC
1307 CROOK AVE
CHEYENNE, WY82001-5412
 Phone: 321-313-3595
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Pediatrics

363LP0200X 50 Nurse Practitioner
Indicates primary specialty

NPI Profile & details for PONY EXPRESS PEDIATRICS, LLC

NPI Number 1265087993
LBN Legal business name PONY EXPRESS PEDIATRICS, LLC
Authorized official CHRISTA KOVACHEVICH - (OWNER/APRN CPNP-PC)
Entity Organization
Organization subpart 1 Yes
Enumeration date 08/08/2019
Last updated 08/08/2019 - About 7 years ago
Identifiers
FL Medicaid 016218600
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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