Kathryn Deluise Liccardo, CPNP-PC

Primary specialty

Pediatric Nurse PractitionerTaxonomy code 363LP0200X

License

APRN-NP223459 Issued in GA

Practice address

4095 S Lee St
Buford, GA 30518-3647

Phone

(770) 932-8519

Fax

(770) 533-4798

NPI assigned

Mar 10, 2020

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Kathryn Louise Deluise Former name

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

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Pediatric Nurse Practitioner

State licenses

Practice roles

Locations

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.

• Northeast Georgia Community Physicians LLC

  • Internal Medicine Physician
  • Gainesville, GA
  • NPI 1881583730
  Medicare reassignment NPD
• The Longstreet Clinic, PC

  • Internal Medicine Physician
  • Gainesville, GA
  • NPI 1326019977
  Medicare reassignment NPD
• The Longstreet Clinic PC

  • Prosthetic/Orthotic Supplier
  • Gainesville, GA
  • NPI 1053422428
  NPD

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

{
    "created_epoch": "1583798400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1761782400000",
    "number": "1497380497",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 658",
            "city": "GAINESVILLE",
            "state": "GA",
            "postal_code": "305030658",
            "telephone_number": "770-718-1122",
            "fax_number": "770-533-4786"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4095 S LEE ST",
            "city": "BUFORD",
            "state": "GA",
            "postal_code": "305183647",
            "telephone_number": "770-932-8519",
            "fax_number": "770-533-4798"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "155 Professional Dr",
            "address_purpose": "LOCATION",
            "city": "Baldwin",
            "state": "GA",
            "postal_code": "305114000",
            "country_code": "US",
            "telephone_number": "706-776-2368",
            "fax_number": "706-776-2589",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1270 Friendship Rd",
            "address_purpose": "LOCATION",
            "city": "Braselton",
            "state": "GA",
            "postal_code": "305175608",
            "country_code": "US",
            "telephone_number": "678-207-4200",
            "fax_number": "770-533-4771",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "725 Jesse Jewell Pkwy SE",
            "address_purpose": "LOCATION",
            "city": "Gainesville",
            "state": "GA",
            "postal_code": "305013834",
            "country_code": "US",
            "telephone_number": "770-535-3611",
            "fax_number": "770-535-7092",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4019 Executive Drive",
            "address_purpose": "LOCATION",
            "city": "Oakwood",
            "state": "GA",
            "postal_code": "305663433",
            "country_code": "US",
            "telephone_number": "770-533-6500",
            "fax_number": "770-533-6543",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LICCARDO",
        "first_name": "KATHRYN",
        "middle_name": "DELUISE",
        "credential": "CPNP-PC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-03-10",
        "last_updated": "2025-10-30",
        "certification_date": "2025-10-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "GA",
            "license": "APRN-NP223459",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KATHRYN",
            "last_name": "DELUISE",
            "middle_name": "LOUISE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Diane M Leopold, OTR/L
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• Iesha Lewis, LAMFT
• Tashaneca Shonte Lewis, FNP-BC
• Guoming Liang
• Lifesaving Hearts Nursing Solutions LLC
• Lifestyles First Medical Equipment and Supplies
• Jeremy L Likens, CSFA
• Lilburn Family Chiropractic LLC
• Hyun Bin Lim, RN

• Pediatric Nurse Practitioner in Buford, GA
• Providers in Buford, GA by specialty
• Pediatric Nurse Practitioner in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.