Individual
MALLORY E LARKIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
15-01709
KS
363AS0400X
Surgical Physician Assistant
PA156716
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
15-01709
STATE LICENSE
KS
05
—
30004345940001
—
KS
01
—
PA156716
STATE LICENSE
OR
Enumeration date
03/12/2012
Last updated
10/11/2023
Update your record
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