Individual
MELISSA DIANE LARSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
13260 SERVICE RD, WALTON, KY 41094-9565
(859) 485-4116
Mailing address
PO BOX 635283, CINCINNATI, OH 45263-5283
(859) 485-4116
(859) 485-1389
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
52180
KY
Other
Enumeration date
09/07/2016
Last updated
07/02/2019
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