Healthcare Provider Details

I. General information

NPI: 1003852955
Provider Name (Legal Business Name): PAULA K LARSEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2006
Last Update Date: 03/07/2024
Certification Date: 03/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 ASHLAND DR STE G1
ASHLAND KY
41101-7084
US

IV. Provider business mailing address

2201 LEXINGTON AVE
ASHLAND KY
41101-2843
US

V. Phone/Fax

Practice location:
  • Phone: 606-408-4900
  • Fax: 606-408-6643
Mailing address:
  • Phone: 606-408-6200
  • Fax: 606-408-6612

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35077269
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code2083P0500X
TaxonomyPreventive Medicine/Occupational Environmental Medicine Physician
License Number33627
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number33627
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: