Provider Demographics
NPI:1912876590
Name:COVENANT MEDICAL SPECIALTY LLC
Entity type:Organization
Organization Name:COVENANT MEDICAL SPECIALTY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSIE
Authorized Official - Middle Name:ERVIN
Authorized Official - Last Name:HINEX
Authorized Official - Suffix:
Authorized Official - Credentials:APRN-CNP
Authorized Official - Phone:918-397-3328
Mailing Address - Street 1:621 17TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:SD
Mailing Address - Zip Code:57401-1446
Mailing Address - Country:US
Mailing Address - Phone:918-397-3328
Mailing Address - Fax:
Practice Address - Street 1:621 17TH AVE NE
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:SD
Practice Address - Zip Code:57401-1446
Practice Address - Country:US
Practice Address - Phone:918-397-3328
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-11-03
Last Update Date:2025-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty