Individual
MALLORY E LARKIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
6265 ROCK CHALK DR STE 1500, LAWRENCE, KS 66049-5232
(785) 843-9125
(785) 505-5312
Mailing address
325 MAINE ST, LAWRENCE, KS 66044-1360
(785) 505-2988
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
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