Healthcare Provider Details

I. General information

NPI: 1528701844
Provider Name (Legal Business Name): SARA JEAN LARSEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2022
Last Update Date: 07/01/2025
Certification Date: 07/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 RAINBOW BLVD # MS 4034
KANSAS CITY KS
66160-6701
US

IV. Provider business mailing address

3901 RAINBOW BLVD # MS 4034
KANSAS CITY KS
66160-8500
US

V. Phone/Fax

Practice location:
  • Phone: 913-588-1959
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number94-12144
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: