Individual
WILLIAM ROBERT REVELETTE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
101 ORCHARD DR, NICHOLASVILLE, KY 40356-2690
(859) 881-4288
(859) 881-4388
Mailing address
215 E 11TH ST, NEWPORT, KY 41071-2203
(859) 655-6100
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
31337
KY
2080A0000X
Pediatric Adolescent Medicine Physician
Primary
31337
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
64313372
—
KY
Enumeration date
03/07/2006
Last updated
06/24/2024
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