Healthcare Provider Details

I. General information

NPI: 1669177408
Provider Name (Legal Business Name): SARAH ELIZABETH VIVERETTE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2023
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 FAIRFIELD AVENUE
BELLEVUE KY
41073-1184
US

IV. Provider business mailing address

P.O. BOX 635283
CINCINNATI OH
45263-5283
US

V. Phone/Fax

Practice location:
  • Phone: 859-431-0090
  • Fax: 859-431-3168
Mailing address:
  • Phone: 859-344-5555
  • Fax: 859-344-5552

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number61487
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: