Individual
TUCKER LLOYD LARSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
427 N 12TH ST., PLUMMER, ID 83851
(208) 686-1931
Mailing address
PO BOX 388, PLUMMER, ID 83851-0388
(208) 686-1931
(208) 686-0242
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
363A00000X
Physician Assistant
Primary
PA-1457
ID
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
07/17/2013
Last updated
12/08/2016
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