KATHRYN DELUISE LICCARDO (CPNP-PC) – Pediatric Nurse Practitioner, NPI 1497380497
Pediatric Nurse Practitioner
Main info
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for KATHRYN DELUISE LICCARDO (CPNP-PC)
155 Professional Dr
Baldwin, GA 305114000
Phone: (706) 776-2368
Fax: (706) 776-2589
Type: Location
1270 Friendship Rd
Braselton, GA 305175608
Phone: (678) 207-4200
Fax: (770) 533-4771
Type: Location
725 Jesse Jewell Pkwy SE
Gainesville, GA 305013834
Phone: (770) 535-3611
Fax: (770) 535-7092
Type: Location
4019 Executive Drive
Oakwood, GA 305663433
Phone: (770) 533-6500
Fax: (770) 533-6543
Type: Location
PO BOX 658
GAINESVILLE, GA 305030658
Phone: (770) 718-1122
Fax: (770) 533-4786
Type: Mailing
4095 S LEE ST
BUFORD, GA 305183647
Phone: (770) 932-8519
Fax: (770) 533-4798
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
Loading prescription activity...
Open Payments (CMS)
CMS reports 12 Open Payments records for all available years, with a total value of $123.
Total Amount is formed as General ($123) + Research ($0) + Ownership ($0) = $123.
Last reported payment date: 2024-10-10 • Largest payer in this snapshot: Corium, LLC ($70).
Total Amount
$123
General + Research + Ownership
Payments
12
Total payment records
General Amount
$123
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-10-10
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| Corium, LLC | $70 |
| SOBI, INC | $19 |
| Merck Sharp & Dohme LLC | $18 |
| SANOFI-AVENTIS U.S. LLC | $17 |
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2020-05-07
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20200507001582 | I | Nurse Practitioner | GA | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 30511)
Loading plans...
Reviews
All reviews are moderated before publication. Reviews reflect users' opinions; we do not verify the accuracy of individual reviews.
No reviews yet. Be the first to share your experience — your opinion helps families compare providers.