Healthcare Provider Details

I. General information

NPI: 1619324852
Provider Name (Legal Business Name): HEATHER LARKINS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2016
Last Update Date: 05/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

284 HIGHWAY 641 N
CAMDEN TN
38320-1350
US

IV. Provider business mailing address

5141 VIRGINIA WAY SUITE 390
BRENTWOOD TN
37027-7572
US

V. Phone/Fax

Practice location:
  • Phone: 731-213-2446
  • Fax: 731-213-2447
Mailing address:
  • Phone: 615-988-1571
  • Fax: 615-988-1635

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number21229
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: