Healthcare Provider Details

I. General information

NPI: 1730513284
Provider Name (Legal Business Name): MRS. CARLA RYAN LARKIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2013
Last Update Date: 09/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1871 MIDLAND TRL
SHELBYVILLE KY
40065-9111
US

IV. Provider business mailing address

1250 SHEPARD WAY
SHELBYVILLE KY
40065-8867
US

V. Phone/Fax

Practice location:
  • Phone: 502-633-2454
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number12-080
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: