Provider Demographics
NPI:1821410705
Name:LIVAS, KARA (NP)
Entity Type:Individual
Prefix:
First Name:KARA
Middle Name:
Last Name:LIVAS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:KARA
Other - Middle Name:
Other - Last Name:GLIMENAKIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 9484
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02940-9484
Mailing Address - Country:US
Mailing Address - Phone:401-854-2504
Mailing Address - Fax:401-854-2519
Practice Address - Street 1:593 EDDY ST
Practice Address - Street 2:CLAVERICK 2
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02903-4923
Practice Address - Country:US
Practice Address - Phone:401-444-5451
Practice Address - Fax:401-444-2922
Is Sole Proprietor?:No
Enumeration Date:2014-01-13
Last Update Date:2018-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIAPRN00377363L00000X
RINPP37812363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110100076AMedicaid
RIU400144295OtherMEDICARE NGS
RIKG96613Medicaid