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NPI Code Detail

MEDICARE: STEFANIE TIERA LIVINGSTON PMHNP

MEDICARE: STEFANIE TIERA LIVINGSTON PMHNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LP0808XPsychiatric/Mental Health Nurse PractitionerAPRN-NP266928GA
2163W00000XRegistered NurseRN266928GA
3363LP0808XPsychiatric/Mental Health Nurse Practitioner5008450NC

General Provider Information

NPI Number : 1487015376
Entity Type Code : Individual
Provider Name (Legal Business Name) : STEFANIE TIERA LIVINGSTON PMHNP
Provider Business Mailing Address
First Line : 4039 GATEWAY BLVD
Second Line :
City : GROVETOWN
State : GA
Zip : 30813-3389
Country : US
Telephone Number : 706-498-9570
Fax Number : 678-369-5762
Provider Business Practice Location Address
First Line : 4039 GATEWAY BLVD
Second Line :
City : GROVETOWN
State : GA
Zip : 30813-3389
Country : US
Telephone Number : 706-498-9570
Fax Number : 678-369-5762
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/19/2016
Last Update Date : 10/23/2025

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