Provider Demographics
NPI:1396015814
Name:LIVINGSTON, KATHY MELINDA (CRNA)
Entity Type:Individual
Prefix:MS
First Name:KATHY
Middle Name:MELINDA
Last Name:LIVINGSTON
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:MS
Other - First Name:KATHY
Other - Middle Name:MELINDA
Other - Last Name:POLEWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:526 TIMBERCHASE LANE
Mailing Address - Street 2:
Mailing Address - City:AIKEN
Mailing Address - State:SC
Mailing Address - Zip Code:29803
Mailing Address - Country:US
Mailing Address - Phone:803-522-1291
Mailing Address - Fax:803-648-2050
Practice Address - Street 1:526 TIMBERCHASE LANE
Practice Address - Street 2:
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29803
Practice Address - Country:US
Practice Address - Phone:803-522-1291
Practice Address - Fax:803-648-2050
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-02
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCAPRN 17846367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered