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KATHRYN DELUISE LICCARDO CPNP-PC
NPI 1497380497
Nurse Practitioner - Pediatrics in Buford, GA

Active since March 10, 2020PECOS Enrolled
4095 S LEE ST, BUFORD, GA 30518(770) 932-8519(770) 533-4798 Get Directions Write a Review

NPPES record last updated: October 30, 2025. Verified against the NPPES registry weekly; last sync: July 26, 2026.

Record update history: Feb 6, 2025, Aug 17, 2023, Jul 8, 2021 and 2 more (5 updates tracked since 2020).

About Kathryn Deluise Liccardo Cpnp-pc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

KATHRYN DELUISE LICCARDO CPNP-PC (NPI 1497380497) is an individual pediatrics provider in Buford, Georgia, licensed in Georgia (APRN-NP223459) and active in the NPI registry since March 2020. She is enrolled in Medicare PECOS and maintains 4 additional practice locations.

NPPES Registry Identity

NPI1497380497
Entity TypeIndividualFemale
Primary Taxonomy363LP0200X
Provider Legal NameKATHRYN DELUISE LICCARDOCredential: CPNP-PC
Location Address4095 S LEE STBuford, GA 30518-3647
Mailing AddressPo Box 658Gainesville, GA 30503-0658 · (770) 718-1122 · Fax (770) 533-4786
Phone(770) 932-8519
Fax(770) 533-4798
Sole ProprietorNo
Enumeration DateMarch 10, 2020
Last NPPES UpdateOctober 30, 20255 updates tracked since enumeration
NPPES CertifiedOctober 30, 2025
✔ NPI 1497380497 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · PediatricsPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LP0200X
License✔ Licensed in GA · APRN-NP223459
4095 S LEE ST, Buford, GA 30518
Open in Google Maps ↗

Other Names 1

Former Name (1)Kathryn Louise Deluise

Secondary Practice Locations 4

Location 1155 Professional DrBaldwin, GA 30511-4000 · Phone (706) 776-2368 · Fax (706) 776-2589
Location 21270 Friendship RdBraselton, GA 30517-5608 · Phone (678) 207-4200 · Fax (770) 533-4771
Location 34019 Executive DriveOakwood, GA 30566-3433 · Phone (770) 533-6500 · Fax (770) 533-6543
Location 4725 Jesse Jewell Pkwy SEGainesville, GA 30501-3834 · Phone (770) 535-3611 · Fax (770) 535-7092

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Absolute Total Care, Ambetter Health, Ambetter of Alabama and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Kathryn Deluise Liccardo Cpnp-pc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 30518 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$88.06 typical visit price
range $56.84 – $172.43
Typical copayment $22.01 (range $14.21 – $43.10)
Most-billed visit code 99203
Established Patient
$100.20 typical visit price
range $18.22 – $140.40
Typical copayment $25.05 (range $4.55 – $35.10)
Most-billed visit code 99214
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 2

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

LAURA FRANTZ PUTNAM MD
Pediatrics
4095 S LEE ST
BUFORD, GA 30518
Gwinnett County (770) 932-8519
RICHARD RUSSELL SHELTON JR. MD
Pediatrics
4095 S LEE ST
BUFORD, GA 30518
Gwinnett County (770) 932-8519

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Kathryn Liccardo's NPI number?

The NPI number for Kathryn Liccardo is 1497380497. It was assigned to this individual provider in the NPPES registry on March 10, 2020. The provider is also known as Kathryn Louise Deluise.

Where is Kathryn Liccardo located?

Kathryn Liccardo practices at 4095 S Lee St, Buford, GA 30518. The listed phone number is (770) 932-8519.

What is Kathryn Liccardo's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Pediatrics, with taxonomy code 363LP0200X.

Is Kathryn Liccardo enrolled in Medicare?

Yes. Kathryn Liccardo is registered in the Medicare PECOS enrollment system.

What insurance does Kathryn Liccardo accept?

Health plans from Ambetter Health, Ambetter from Absolute Total Care, Ambetter of Alabama, Ambetter of North Carolina and Ambetter of Tennessee list Kathryn Liccardo as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Kathryn Liccardo was last updated on October 30, 2025. NPI Profile syncs with the weekly NPPES data releases published by CMS.