Active NPI
Audrey Kovalak, RN
- Registered Nurse
- Mentor, OH
National Provider Identifier
1922469626
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Nurse
- License
- RN.494090
- Practice address
- 7232 Justin Way
Mentor, OH 44060-4881 - Phone
- (440) 578-8200
- NPI assigned
- Mar 9, 2016
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | RN.494090 | OH | Primary |
Addresses
Primary practice location
7232 Justin Way
Mentor, OH 44060-4881
Mailing address
7232 Justin Way
Mentor, OH 44060-4881
Phone (440) 578-8200
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0160235 | Medicaid | OH |
Other names 1
- Audrey Gillespie
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RN.494090 | OH | MD | Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1457481600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1651104000000",
"number": "1922469626",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7232 JUSTIN WAY",
"city": "MENTOR",
"state": "OH",
"postal_code": "440604881",
"telephone_number": "440-578-8200"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7232 JUSTIN WAY",
"city": "MENTOR",
"state": "OH",
"postal_code": "440604881",
"telephone_number": "440-578-8200"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KOVALAK",
"first_name": "AUDREY",
"credential": "RN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2016-03-09",
"last_updated": "2022-04-28",
"certification_date": "2022-04-28",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "OH",
"license": "RN.494090",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0160235",
"state": "OH"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "AUDREY",
"last_name": "GILLESPIE",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Mentor, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.