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General NPI Number Information
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NPI Number | 1407838311
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Entity Type | Individual
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Provider Name | MELLISA L LARKIN A.R.N.P
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Gender | Female
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Dates
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Enumeration Date | 11/16/2005
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Last Update Date | 12/10/2020
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Provider Practice Location Address
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Address Line | 4001 KRESGE WAY SUITE 100
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City | LOUISVILLE
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State | KY
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Zip | 40207-4640
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Country | US
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Telephone | 502-897-6579
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Fax | 502-897-2725
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Provider Business Mailing Address
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Address Line | 5200 COMMERCE CROSSING, 3RD FLOOR
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City | LOUISVILLE
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State | KY
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Zip | 40229
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Country | US
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Telephone | 502-253-4924
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Fax | 502-489-5750
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 3002601
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License Number State | KY
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