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NPI Code Detail

MEDICARE: LEVITA J LARSON

MEDICARE: LEVITA J LARSON
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
1363L00000XNurse Practitioner3012422KY

General Provider Information

NPI Number : 1144789678
Entity Type Code : Individual
Provider Name (Legal Business Name) : LEVITA J LARSON
Provider Business Mailing Address
First Line : 333 BEACON HILL RD STE 201
Second Line :
City : MOREHEAD
State : KY
Zip : 40351-6182
Country : US
Telephone Number : 606-780-0444
Fax Number : 606-780-4545
Provider Business Practice Location Address
First Line : 333 BEACON HILL RD STE 201
Second Line :
City : MOREHEAD
State : KY
Zip : 40351-6182
Country : US
Telephone Number : 606-780-0444
Fax Number : 606-784-2344
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/14/2019
Last Update Date : 03/14/2019

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