Healthcare Provider Details

I. General information

NPI: 1265092738
Provider Name (Legal Business Name): ESRA PEHLIVAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2019
Last Update Date: 08/28/2025
Certification Date: 08/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2195 HARRODSBURG RD STE 2
LEXINGTON KY
40504-3516
US

IV. Provider business mailing address

1 CHILDRENS PL # 3S34
SAINT LOUIS MO
63110-1002
US

V. Phone/Fax

Practice location:
  • Phone: 859-562-1868
  • Fax: 859-257-0421
Mailing address:
  • Phone: 314-454-6006
  • Fax: 314-454-4102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2019021242
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code2084E0001X
TaxonomyEpilepsy Physician
License Number60149
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number2024006552
License Number StateMO
# 4
Primary TaxonomyY
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License Number60149
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: