Individual provider Active NPI

Tracey Q Livingston, ANP-BC

  • Adult Health Nurse Practitioner
  • Valdasta, GA
National Provider Identifier
1578869830
Registry record updated Nov 30, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
RN130337 Issued in GA
Practice address
3328 Bemiss Rd
Valdasta, GA 31605
Phone
(229) 469-6137
Fax
(229) 469-6139
NPI assigned
Feb 4, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 30, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Nurse Practitioner 363LA2200X RN130337 NP GA
Adult Health Nurse Practitioner 363LA2200X RN130337 GA Primary

Addresses

Primary practice location

3328 Bemiss Rd
Valdasta, GA 31605

Mailing address

3328 Bemiss Rd
Valdasta, GA 31605
Phone (229) 469-6137

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
I20110523000168 GA Practitioner - Nurse Practitioner 7416133707 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

3328 Bemiss Rd
Valdosta, GA 31605-7014
Phone (229) 469-6137

Hospital & facility affiliations

  • SGMC Health Hospital, Valdosta, GA, CCN 110122

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
RN130337GAMDAdult Health Nurse Practitioner
RN130337 NPGAMDAdult Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Sutherland Physical Therapy, Inc. CurrentSince Dec 1, 2014 Accepting new patients
Valdosta Health & Wellness Clinic Inc Adult Health CurrentSince Dec 1, 2014 Accepting new patients

Locations

3328 Bemiss Rd
Valdosta, GA 31605
Phone (229) 244-1201

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.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1296777600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1638230400000",
    "number": "1578869830",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3328 BEMISS RD",
            "city": "VALDASTA",
            "state": "GA",
            "postal_code": "31605",
            "telephone_number": "229-469-6137",
            "fax_number": "229-469-6139"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3328 BEMISS RD",
            "city": "VALDASTA",
            "state": "GA",
            "postal_code": "31605",
            "telephone_number": "229-469-6137",
            "fax_number": "229-469-6139"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LIVINGSTON",
        "first_name": "TRACEY",
        "middle_name": "Q",
        "name_prefix": "Mrs.",
        "credential": "ANP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-02-04",
        "last_updated": "2021-11-30",
        "certification_date": "2021-11-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "GA",
            "license": "RN130337 NP",
            "primary": false
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "GA",
            "license": "RN130337",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Sources for this page

Verify at the official NPI Registry.