Provider Demographics
NPI:1083038723
Name:LICARI, DEVON E (ARNP, FNP)
Entity Type:Individual
Prefix:
First Name:DEVON
Middle Name:E
Last Name:LICARI
Suffix:
Gender:F
Credentials:ARNP, FNP
Other - Prefix:
Other - First Name:DEVON
Other - Middle Name:E
Other - Last Name:MCCAFFERTY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 751649
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1649
Mailing Address - Country:US
Mailing Address - Phone:843-789-1620
Mailing Address - Fax:843-724-2440
Practice Address - Street 1:319 FOLLY RD
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29412-2518
Practice Address - Country:US
Practice Address - Phone:843-203-2246
Practice Address - Fax:843-203-2247
Is Sole Proprietor?:No
Enumeration Date:2014-02-18
Last Update Date:2021-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC19210363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP3094Medicaid
FLARNP9329177OtherARNP
SCNP3094Medicaid