Individual provider Active NPI

Stefanie Tiera Livingston, PMHNP

  • Psychiatric/Mental Health Nurse Practitioner
  • Grovetown, GA
National Provider Identifier
1487015376
Registry record updated Oct 23, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
APRN-NP266928 Issued in GA
Practice address
4039 Gateway Blvd
Grovetown, GA 30813-3389
Phone
(706) 498-9570
Fax
(678) 369-5762
NPI assigned
Mar 19, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 23, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X APRN-NP266928 GA Primary
Registered Nurse 163W00000X RN266928 GA
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 5008450 NC

Addresses

Primary practice location

4039 Gateway Blvd
Grovetown, GA 30813-3389

Mailing address

4039 Gateway Blvd
Grovetown, GA 30813-3389
Phone (706) 498-9570

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210924001284 GA Practitioner - Nurse Practitioner 5395018386 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
University of Alabama School of Medicine, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Personal Recovery Network LLCGroup PAC ID 5092611384, 612 clinicians

Practice addresses (Care Compare)

3633 Wheeler Rd
Suite 365
Augusta, GA 30909-6544
Phone (706) 432-6866

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
APRN-NP266928GAMDPsychiatric/Mental Health Nurse Practitioner
5008450NCMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Personal Recovery Network LLC CurrentSince Sep 9, 2021 Accepting new patients
Rowan Medical Practices, Inc. Past Accepting new patients

Locations

3633 Wheeler Rd
Ste 365
Augusta, GA 30909
Phone (706) 432-6866

4039 Gateway Blvd
Grovetown, GA 30813
Phone (706) 498-9570

4039 Gateway Blvd
Ste 201
Grovetown, GA 30813
Phone (706) 432-6866

250 Corporate Center Ct
Stockbridge, GA 30281
Phone (770) 954-8685

Interoperability endpoints

  • Direct secure messaging: slivingston@landmarkhealth-direct.org
  • Direct secure messaging: georgiabehavioralhealthprofessionals.stefanielivingston@124220.advancedmd-direct.com

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1458345600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1761177600000",
    "number": "1487015376",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4039 GATEWAY BLVD",
            "city": "GROVETOWN",
            "state": "GA",
            "postal_code": "308133389",
            "telephone_number": "706-498-9570",
            "fax_number": "678-369-5762"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4039 GATEWAY BLVD",
            "city": "GROVETOWN",
            "state": "GA",
            "postal_code": "308133389",
            "telephone_number": "706-498-9570",
            "fax_number": "678-369-5762"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LIVINGSTON",
        "first_name": "STEFANIE",
        "middle_name": "TIERA",
        "credential": "PMHNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-03-19",
        "last_updated": "2025-10-23",
        "certification_date": "2025-10-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "GA",
            "license": "APRN-NP266928",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "GA",
            "license": "RN266928",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NC",
            "license": "5008450",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grovetown, GA

Sources for this page

Verify at the official NPI Registry.