MRS. HEATHER LARSON AGACNP-BC NPI 1114724317

NPI Information

  • NPI: 1114724317
  • Provider Name: MRS. HEATHER LARSON, AGACNP-BC
  • Classification: Nurse Practitioner - 363LG0600X
  • Specialization: Gerontology
  • Entity Type: Individual
  • PECOS Registration: Yes
  • Address: 200 E PENNSYLVANIA AVE
    PEORIA, IL
    ZIP 61603
  • Phone: (309) 655-2000

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NPI Details

MRS. Heather Larson, AGACNP-BC is a gerontology nurse practitioner in Peoria, IL with 2 years of experience. MRS. Heather Larson, AGACNP-BC NPI is 1114724317. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

200 E PENNSYLVANIA AVE
PEORIA, IL
ZIP 61603-089
Phone: (309) 655-2000

The NPI 1114724317 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 2/26/2025 and was last updated on 3/11/2025.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1363LA2100XNurse PractitionerAcute Care209.031767ILLINOISNo
2390200000XStudent in an Organized Health Care Education/Training ProgramNo
3363LG0600XNurse PractitionerGerontology209031767ILLINOISYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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