Individual
KATHRYN DELUISE LICCARDO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CPNP-PC
Contact information
Practice address
4095 S LEE ST, BUFORD, GA 30518-3647
(770) 932-8519
(770) 533-4798
Mailing address
PO BOX 658, GAINESVILLE, GA 30503-0658
(770) 718-1122
(770) 533-4786
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
APRN-NP223459
GA
Other
Enumeration date
03/10/2020
Last updated
10/30/2025
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