Healthcare Provider Details

I. General information

NPI: 1033263207
Provider Name (Legal Business Name): KATHLEEN LOUISE PAVEL PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 10/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5855 CREEK STATION DR
PENSACOLA FL
32504-8626
US

IV. Provider business mailing address

2315 W JACKSON ST
PENSACOLA FL
32505-7552
US

V. Phone/Fax

Practice location:
  • Phone: 850-435-4352
  • Fax: 850-497-6195
Mailing address:
  • Phone: 850-436-4630
  • Fax: 850-436-2095

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA9110987
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: