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Individual

KELLIE D LARSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA-C

Contact information

Practice address
8201 NORTHWOODS DR, LINCOLN, NE 68505-3092
(402) 465-5600
(402) 327-6017
Mailing address
8201 NORTHWOODS DR, LINCOLN, NE 68505-3092
(402) 465-5600
(402) 327-6074

Taxonomy

Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
737
NE

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
10025151600
NE
05
10026368300
NE
05
47079049100
NE
05
47079049112
NE
Enumeration date
12/29/2005
Last updated
03/06/2017
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