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General NPI Number Information
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NPI Number | 1790664399
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Entity Type | Individual
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Provider Name | ASHLYN LARSEN LANFORD
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Gender |
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Dates
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Enumeration Date | 08/28/2025
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Last Update Date | 08/28/2025
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Provider Practice Location Address
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Address Line | 6965 CUMBERLAND GAP PKWY
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City | HARROGATE
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State | TN
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Zip | 37752-8245
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Country | US
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Telephone | 423-869-3611
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Fax |
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Provider Business Mailing Address
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Address Line | 127 CEDAR SWAMP RD
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City | TOLLAND
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State | CT
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Zip | 06084-3611
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Country | US
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Telephone | 860-874-8866
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Fax |
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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 |
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License Number State |
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