Healthcare Provider Details

I. General information

NPI: 1003438953
Provider Name (Legal Business Name): REA PAVATE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2020
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date: 01/17/2022
Reactivation Date: 02/02/2022

III. Provider practice location address

200 CARDINAL DR STE 413
ELIZABETHTOWN KY
42701-2795
US

IV. Provider business mailing address

9636 RIVER TRAIL DR
LOUISVILLE KY
40229-5221
US

V. Phone/Fax

Practice location:
  • Phone: 270-706-5787
  • Fax: 270-706-5788
Mailing address:
  • Phone: 270-706-5787
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number58319
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: