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General NPI Number Information
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NPI Number | 1982615860
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Entity Type | Individual
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Provider Name | TATYANA RYBAKOVA
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Gender | Female
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Dates
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Enumeration Date | 08/10/2006
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Last Update Date | 04/17/2014
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Provider Practice Location Address
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Address Line | 2141 SPENCER CT
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City | LA GRANGE
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State | KY
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Zip | 40031-6742
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Country | US
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Telephone | 502-589-8600
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Fax | 502-589-8771
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Provider Business Mailing Address
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Address Line | 101 W MUHAMMAD ALI BLVD
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City | LOUISVILLE
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State | KY
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Zip | 40202-1954
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Country | US
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Telephone | 502-589-8600
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Fax | 502-589-8771
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | 39344
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License Number State | KY
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