KBVE Application for Veterinary Facility Registration Kentucky Board of Veterinary Examiners


IV. Registered Facility Licensee Information Name of Veterinarian(s), if applicable*


License Number


Application for Veterinary Facility Registration


Employment Status (Direct employee, contract work, fulltime, parttime, etc.)


Name of LVT(s), if applicable*


License Number


Employment Status


Name of AAHP(s), if applicable*


Permit Number


Employment Status


*Attach additional pages as necessary.


Submit Complete Application to: Kentucky Board of Veterinary Examiners 4047 Iron Works Parkway, Suite 104


Lexington, Kentucky 40511 KVMA News | Spring 2025 Page 3 of 6


Form Last Updated: 2/2025 MIR: 201 KAR 16:762


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