Provider Type Icon

NINO KAVTARADZE CRNP NPI 1639574841


NPI Information

NPI: 1639574841
Provider Name: NINO KAVTARADZE, CRNP
Classification: Nurse Practitioner - 363L00000X
Entity Type: Individual

PECOS Registration: Yes

Address:
1200 BUSTLETON PIKE STE 16A3
FEASTERVILLE TREVOSE, PA
ZIP 19053
Phone: (267) 574-5236
Get Directions

Nino Kavtaradze, CRNP is a nurse practitioner in Feasterville Trevose, PA. The provider is (1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners. Nino Kavtaradze, CRNP NPI is 1639574841. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

1200 BUSTLETON PIKE STE 16A3
FEASTERVILLE TREVOSE, PA
ZIP 19053-118
Phone: (267) 574-5236

The NPI 1639574841 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 10/30/2014 and was last updated on 1/29/2020.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1163W00000XRegistered NurseRN632493PENNSYLVANIANo
2363L00000XNurse PractitionerSP015632PENNSYLVANIAYes
3363LF0000XNurse PractitionerFamilySP015632PENNSYLVANIANo

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
11032670520017MEDICAIDPENNSYLVANIA
2RN632493OTHERPENNSYLVANIAPENNSYLVANIA DEPARTMENT OF STATE
333402683OTHERAMERICAN NURSES CREDENTIALING CENTER (ANCC)
4SP015632OTHERPENNSYLVANIAPENNSYLVANIA DEPARTMENT OF STATE

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.