Practitioner LLC
Practitioner LLC is a healthcare organization registered as Primary Care Nurse Practitioner in Feasterville Trevose, PA, holding Type 2 (organization) NPI 1497316996 since 2019. The authorized official on file is Nino Kavtaradze, Primary Care Provider, Shareholder.
✓ Active NPI ✓ Valid NPI checksum
| NPI | 1497316996 |
|---|---|
| Entity type | Organization (Type 2) |
| Legal business name | Practitioner LLC |
| Other name | <Unavail> |
| Practice address | 1200 BUSTLETON PIKE STE 16A3, Feasterville Trevose, PA, 19053 |
| Phone | 2672237738 |
| Fax | 8774160367 |
| Enumeration date | 2019-06-25 |
| Last updated in NPPES | 2020-01-29 |
Authorized official
| Name | Nino Kavtaradze |
|---|---|
| Title | Primary Care Provider, Shareholder |
| Phone | 2672237738 |
Taxonomy & classification
| Taxonomy code | Specialty | Primary | License | State |
|---|---|---|---|---|
| 363LP2300X | Primary Care Nurse Practitioner | Primary | — | — |
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1037033750001 | Medicaid | PA | — |
Copy-ready billing details
Provider: Practitioner LLC NPI: 1497316996 Taxonomy: 363LP2300X (Primary Care Nurse Practitioner) Address: 1200 BUSTLETON PIKE STE 16A3, Feasterville Trevose, PA, 19053
Providers at this address
| NPI | Name | Type | Specialty | Location |
|---|---|---|---|---|
| 1639574841 | Nino Kavtaradze | Individual | Nurse Practitioner | Feasterville Trevose, PA |
Verify this record
Cross-check NPI 1497316996 against the authoritative CMS record: view Practitioner LLC on the official NPPES registry .
What is an NPI number?
A National Provider Identifier (NPI) is a unique 10-digit number that CMS assigns to every U.S. healthcare provider and organization under HIPAA. Type 1 NPIs identify individual providers; Type 2 NPIs identify organizations. The NPI appears on insurance claims, prescriptions, and credentialing paperwork, and never changes — even if the provider moves or changes specialty. Read the full guide or validate an NPI number.
Frequently asked questions
What is the NPI number for Practitioner LLC?
Who is the authorized official for Practitioner LLC?
Source: CMS NPPES (public data). Snapshot 2026-07-11. Provider record last updated 2020-01-29.