Provider Demographics
NPI:1275946337
Name:LIVINGSTON FAMILY PRACTICE, PLLC
Entity Type:Organization
Organization Name:LIVINGSTON FAMILY PRACTICE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:SHENIE
Authorized Official - Last Name:LIVINGSTON
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:615-328-6206
Mailing Address - Street 1:118 MCMURRY BLVD E
Mailing Address - Street 2:
Mailing Address - City:HARTSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37074-1108
Mailing Address - Country:US
Mailing Address - Phone:615-680-3331
Mailing Address - Fax:615-680-3332
Practice Address - Street 1:118 MCMURRY BLVD E
Practice Address - Street 2:
Practice Address - City:HARTSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37074-1108
Practice Address - Country:US
Practice Address - Phone:615-680-3331
Practice Address - Fax:615-680-3332
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-06
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN14439363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ006917Medicaid