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General NPI Number Information
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NPI Number | 1821457870
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Entity Type | Individual
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Provider Name | KATHLEEN LICKFELDT NP-C
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Gender | Female
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Dates
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Enumeration Date | 02/18/2016
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Last Update Date | 10/15/2024
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Provider Practice Location Address
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Address Line | 930 GERMANTOWN PIKE
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City | PLYMOUTH MEETING
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State | PA
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Zip | 19462-7400
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Country | US
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Telephone | 484-476-1000
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Fax |
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Provider Business Mailing Address
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Address Line | 3803 W CHESTER PIKE STE 160
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City | NEWTOWN SQUARE
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State | PA
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Zip | 19073-2336
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 9288359
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | SP029917
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License Number State | PA
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