Individual
KETIA MPOVILA MBIYAVANGA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1733 HAROLD AVE, LOUISVILLE, KY 40210-2227
(859) 693-1407
Mailing address
509 GREEN VALLEY DR, LEXINGTON, KY 40511-8851
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
09/30/2025
Last updated
09/30/2025
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