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Practitioner LLC

Primary Care Nurse Practitioner in Feasterville Trevose, PA · enumerated 2019 · authorized official Nino Kavtaradze, Primary Care Provider, Shareholder.

Data current as of Jul 13, 2026 · sourced from CMS NPPES

National Provider Identifier

1497316996

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Registry record

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 (267) 223-7738
Fax (877) 416-0367
Enumeration date Jun 25, 2019
Last updated in NPPES Jan 29, 2020

Taxonomy & classification

363LP2300X Primary Care Nurse Practitioner Physician Assistants & Advanced Practice Nursing Providers Primary

Authorized official

Name Nino Kavtaradze
Title Primary Care Provider, Shareholder
Phone (267) 223-7738

Other identifiers

Identifier Type State Issuer
1037033750001 Medicaid PA -

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.

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Frequently asked questions

What is the NPI number for Practitioner LLC?
The NPI for Practitioner LLC is 1497316996, a Type 2 (organization) record in the CMS NPPES registry.
Who is the authorized official for Practitioner LLC?
NPPES lists Nino Kavtaradze (Primary Care Provider, Shareholder) as the authorized official for this organization.

Providers at this address

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Source: CMS NPPES (public data). Snapshot 2026-07-13. Provider record last updated 2020-01-29.