Individual
KIMBERLY S LARSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
N.P.
Contact information
Practice address
170 ARROWHEAD DR, EVANSTON, WY 82930-9266
(307) 789-0096
(307) 789-0860
Mailing address
1573 MALLORY LN, STE 100, BRENTWOOD, TN 37027-2895
(615) 221-3855
(615) 221-1484
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
18217.0308
WY
363LF0000X
Family Nurse Practitioner
363542-4405
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
120048800
—
WY
Enumeration date
08/08/2006
Last updated
10/04/2016
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