Provider Demographics
NPI:1477826451
Name:COLLETON-LIVINGSTON, KIA LATEA (NP-C)
Entity Type:Individual
Prefix:
First Name:KIA
Middle Name:LATEA
Last Name:COLLETON-LIVINGSTON
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:836 OAK MANOR DR SE
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-0053
Mailing Address - Country:US
Mailing Address - Phone:336-408-5630
Mailing Address - Fax:
Practice Address - Street 1:836 OAK MANOR DR SE
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-0053
Practice Address - Country:US
Practice Address - Phone:336-408-5630
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-21
Last Update Date:2024-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC218559363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health