Provider Demographics
NPI:1598402349
Name:BATOVSKY, THAO
Entity Type:Individual
Prefix:
First Name:THAO
Middle Name:
Last Name:BATOVSKY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13410 EASTPOINT CENTRE DR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-4160
Mailing Address - Country:US
Mailing Address - Phone:877-662-6633
Mailing Address - Fax:
Practice Address - Street 1:13410 EASTPOINT CENTRE DR
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40223-4160
Practice Address - Country:US
Practice Address - Phone:877-662-6633
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-13
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1136448163W00000X
390200000X
KY023063183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No163W00000XNursing Service ProvidersRegistered Nurse
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program