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1144301458

NPI Code Detail

MEDICARE: ASHLEY J LARSEN PAC

MEDICARE: ASHLEY J LARSEN PAC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	PA00156	MS
2	363AS0400X	Surgical Physician Assistant	200067	LA
3	363LC0200X	Critical Care Medicine Nurse Practitioner	PA00156	MS
4	363AM0700X	Medical Physician Assistant	PA-519	AL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	302I970729	OTHER	MS	MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1144301458
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEY J LARSEN PAC

Provider Business Mailing Address
First Line	:	2101 HIGHWAY 90
Second Line	:
City	:	GAUTIER
State	:	MS
Zip	:	39553-5340
Country	:	US
Telephone Number	:	228-872-1951
Fax Number	:	228-875-9998

Provider Business Practice Location Address
First Line	:	3635 BIENVILLE BLVD
Second Line	:
City	:	OCEAN SPRINGS
State	:	MS
Zip	:	39564-5711
Country	:	US
Telephone Number	:	228-872-1951
Fax Number	:	228-875-9998

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/17/2006
Last Update Date	:	04/16/2026

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Directions to “ ASHLEY J LARSEN PAC” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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