Healthcare Provider Details

I. General information

NPI: 1922980150
Provider Name (Legal Business Name): EMMA NICOLE PAVNICA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2025
Last Update Date: 07/21/2025
Certification Date: 07/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4305 NEW SHEPHERDSVILLE RD
BARDSTOWN KY
40004-1299
US

IV. Provider business mailing address

300 AXIS DR APT 111
LOUISVILLE KY
40206-0077
US

V. Phone/Fax

Practice location:
  • Phone: 502-350-5000
  • Fax:
Mailing address:
  • Phone: 331-302-0857
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: