Healthcare Provider Details

I. General information

NPI: 1255143400
Provider Name (Legal Business Name): ABBY LARSON APRN, CNP, PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2025
Last Update Date: 04/14/2026
Certification Date: 04/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1833 W US HIGHWAY 2 STE C
GRAND RAPIDS MN
55744-4733
US

IV. Provider business mailing address

1833 W US HIGHWAY 2 STE C
GRAND RAPIDS MN
55744-4733
US

V. Phone/Fax

Practice location:
  • Phone: 218-297-5866
  • Fax: 218-885-8840
Mailing address:
  • Phone: 218-297-5866
  • Fax: 218-885-8840

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number12486
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: