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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: October 18, 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 1725 Jesse Jewell Pkwy SEGainesville, GA 30501-3834 · Phone (770) 535-3611 · Fax (770) 535-7092
Location 21270 Friendship RdBraselton, GA 30517-5608 · Phone (678) 207-4200 · Fax (770) 533-4771
Location 3155 Professional DrBaldwin, GA 30511-4000 · Phone (706) 776-2368 · Fax (706) 776-2589
Location 44019 Executive DriveOakwood, GA 30566-3433 · Phone (770) 533-6500 · Fax (770) 533-6543

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

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.

Medicare Billing Reassignments

2

Medicare enrollment records show Kathryn Liccardo reassigns Medicare billing to 2 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

The Longstreet Clinic, PC
18 mi
Internal Medicine
725 JESSE JEWELL PKWY SE
Gainesville, GA 30501
  • Reassigned Medicare billing, Georgia enrollment
  • 170 clinicians in this Medicare group
NPI 1326019977 (770) 718-1122
Northeast Georgia Community Physicians LLC
18 mi
Internal Medicine
743 SPRING ST NE
Gainesville, GA 30501
  • Reassigned Medicare billing, Georgia enrollment
  • 161 clinicians in this Medicare group
NPI 1881583730 (770) 219-9000

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

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.

Which organizations bill Medicare for Kathryn Liccardo's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Kathryn Liccardo reassigns Medicare benefits to 2 organizations: The Longstreet Clinic, PC (Gainesville, GA) and Northeast Georgia Community Physicians LLC (Gainesville, GA). Each reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Kathryn Liccardo's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

When was this NPI record last updated?

The NPPES record for Kathryn Liccardo was last updated on October 30, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 11 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.