Healthcare Provider Details

I. General information

NPI: 1942955059
Provider Name (Legal Business Name): KAITLYN LARKIN PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/16/2022
Last Update Date: 09/28/2026
Certification Date: 02/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6620 FLY ROAD STE 305
E SYRACUSE NY
13057
US

IV. Provider business mailing address

251 SALINA MEADOWS PARKWAY SUITE 100
SYRACUSE NY
13212
US

V. Phone/Fax

Practice location:
  • Phone: 315-464-3938
  • Fax: 315-464-5359
Mailing address:
  • Phone: 315-464-2096
  • Fax: 315-464-2010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number035861
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: