Healthcare Provider Details

I. General information

NPI: 1053801894
Provider Name (Legal Business Name): LARISA LYNN HAMMOND APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2018
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7168 SADDLE MOUNTAIN RD
BOZEMAN MT
59715-8502
US

IV. Provider business mailing address

7168 SADDLE MOUNTAIN RD
BOZEMAN MT
59715-8502
US

V. Phone/Fax

Practice location:
  • Phone: 406-600-2700
  • Fax:
Mailing address:
  • Phone: 406-600-2700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number130501
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: