Provider Demographics
NPI:1922980150
Name:PAVNICA, EMMA NICOLE
Entity type:Individual
Prefix:
First Name:EMMA
Middle Name:NICOLE
Last Name:PAVNICA
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 1:300 AXIS DR APT 111
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40206-0077
Mailing Address - Country:US
Mailing Address - Phone:331-302-0857
Mailing Address - Fax:
Practice Address - Street 1:4305 NEW SHEPHERDSVILLE RD
Practice Address - Street 2:
Practice Address - City:BARDSTOWN
Practice Address - State:KY
Practice Address - Zip Code:40004-1299
Practice Address - Country:US
Practice Address - Phone:502-350-5000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-21
Last Update Date:2025-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service