1316374754 NPI number — ROBERTA DARLENE LIVINGSTON LMP

Table of content: ROBERTA DARLENE LIVINGSTON LMP (NPI 1316374754)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316374754 NPI number — ROBERTA DARLENE LIVINGSTON LMP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LIVINGSTON
Provider First Name:
ROBERTA
Provider Middle Name:
DARLENE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LMP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1316374754
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/16/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5219 W CLEARWATER AVE STE 14
Provider Second Line Business Mailing Address:
MARINELAND EAST
Provider Business Mailing Address City Name:
KENNEWICK
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
99336-1980
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-572-2900
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
815 S AUBURN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KENNEWICK
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99336-5661
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-947-2572
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/30/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225700000X , with the licence number:  MA60401637 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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