Individual
KATHLEEN LICKFELDT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP-C
Contact information
Practice address
930 GERMANTOWN PIKE, PLYMOUTH MEETING, PA 19462-7400
(484) 476-1000
Mailing address
3803 W CHESTER PIKE STE 160, NEWTOWN SQUARE, PA 19073-2336
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
SP029917
PA
363LA2200X
Adult Health Nurse Practitioner
9288359
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
025086800
—
FL
01
—
V68RY
BLUE CROSS
FL
Enumeration date
02/18/2016
Last updated
10/15/2024
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