Provider Demographics
NPI:1174729354
Name:LARRISON, LAURA JEAN (RNP)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:JEAN
Last Name:LARRISON
Suffix:
Gender:F
Credentials:RNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 21850
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71903-1850
Mailing Address - Country:US
Mailing Address - Phone:501-622-4170
Mailing Address - Fax:501-627-1899
Practice Address - Street 1:100 MCGOWAN CT
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71913-6452
Practice Address - Country:US
Practice Address - Phone:501-622-4170
Practice Address - Fax:501-627-1899
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP00389363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5S888Medicare ID - Type Unspecified
R76843Medicare UPIN