Provider Demographics
NPI:1487726915
Name:COVERSTON, KIRK DARIN (MD)
Entity type:Individual
Prefix:DR
First Name:KIRK
Middle Name:DARIN
Last Name:COVERSTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1415 N. ACACIA AVE. SUITE#101
Mailing Address - Street 2:
Mailing Address - City:REEDLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93654-2102
Mailing Address - Country:US
Mailing Address - Phone:559-638-8187
Mailing Address - Fax:559-638-3883
Practice Address - Street 1:1415 N ACACIA AVE STE 101
Practice Address - Street 2:
Practice Address - City:REEDLEY
Practice Address - State:CA
Practice Address - Zip Code:93654-2102
Practice Address - Country:US
Practice Address - Phone:559-638-8187
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA81698174400000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA81698OtherM.D.
BC8257520OtherDEA
CAI00025Medicare UPIN