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General NPI Number Information
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NPI Number | 1457686826
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Entity Type | Individual
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Provider Name | LARRY W NYE PA-C
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Gender | Male
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Dates
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Enumeration Date | 10/02/2009
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Last Update Date | 02/13/2024
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Provider Practice Location Address
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Address Line | 969 STEVENS DR STE 3A
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City | RICHLAND
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State | WA
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Zip | 99352-3558
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Country | US
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Telephone | 509-713-1315
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Fax | 866-422-7049
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Provider Business Mailing Address
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Address Line | 969 STEVENS DR STE 3A
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City | RICHLAND
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State | WA
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Zip | 99352-3558
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Country | US
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Telephone | 509-713-1315
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Fax | 866-422-7049
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA60102449
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License Number State | WA
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