Basic Information
| Provider Information | |||||||||
| NPI: | 1447897442 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PAVEY | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | RAY | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2451 INTELLIPLEX DR | ||||||||
| Address2: | |||||||||
| City: | SHELBYVILLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 461768580 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3174211987 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2451 INTELLIPLEX DR STE 295 | ||||||||
| Address2: | |||||||||
| City: | SHELBYVILLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 461768580 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3173985237 | ||||||||
| FaxNumber: | 3178255316 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/09/2019 | ||||||||
| LastUpdateDate: | 12/09/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/09/2019 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WU0100X | 28182829A | IN | N | Nursing Service Providers | Registered Nurse | Urology | 363L00000X | 28182829A | IN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.