Healthcare Provider Details

I. General information

NPI: 1386551810
Provider Name (Legal Business Name): ANNA MATHIS LARSON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2026
Last Update Date: 08/27/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

604 S MAIN ST
WATER VALLEY MS
38965-3468
US

IV. Provider business mailing address

604 S MAIN ST
WATER VALLEY MS
38965-3468
US

V. Phone/Fax

Practice location:
  • Phone: 662-473-4050
  • Fax: 662-473-4191
Mailing address:
  • Phone: 662-473-4050
  • Fax: 662-473-4191

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number908736
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: