KATHRYN DELUISE LICCARDO CPNP-PC NPI 1497380497

NPI Information

NPI: 1497380497
Provider Name: KATHRYN DELUISE LICCARDO, CPNP-PC
Classification: Nurse Practitioner - 363LP0200X
Entity Type: Individual

Specialization: Pediatrics

PECOS Registration: Yes

Address:
4095 S LEE ST
BUFORD, GA
ZIP 30518
Phone: (770) 932-8519
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Kathryn Deluise Liccardo, CPNP-PC is a pediatrics nurse practitioner in Buford, GA. Kathryn Deluise Liccardo, CPNP-PC NPI is 1497380497. The provider is registered as an individual entity type and is a multi-specialty group.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

4095 S LEE ST
BUFORD, GA
ZIP 30518-647
Phone: (770) 932-8519
Fax: (770) 533-4798

The NPI 1497380497 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 3/10/2020 and was last updated on 8/17/2023.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363LP0200X	Nurse Practitioner	Pediatrics	RN223459	GEORGIA	Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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