Provider Demographics
NPI:1538590658
Name:LIVINGSTON, KELLY (ND)
Entity type:Individual
Prefix:DR
First Name:KELLY
Middle Name:
Last Name:LIVINGSTON
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 STEEPLE TOP RD
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06853-1039
Mailing Address - Country:US
Mailing Address - Phone:203-856-1666
Mailing Address - Fax:
Practice Address - Street 1:21 STEEPLE TOP RD
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06853-1039
Practice Address - Country:US
Practice Address - Phone:203-856-1666
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-30
Last Update Date:2013-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT504175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath