Healthcare Provider Details

I. General information

NPI: 1598402349
Provider Name (Legal Business Name): THAO BATOVSKY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2022
Last Update Date: 08/23/2022
Certification Date: 08/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13410 EASTPOINT CENTRE DR
LOUISVILLE KY
40223-4160
US

IV. Provider business mailing address

13410 EASTPOINT CENTRE DR
LOUISVILLE KY
40223-4160
US

V. Phone/Fax

Practice location:
  • Phone: 877-662-6633
  • Fax:
Mailing address:
  • Phone: 877-662-6633
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1136448
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number023063
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: