JACK LARSEN NPI 1972063444

NPI Information

NPI: 1972063444
Provider Name: JACK LARSEN
Classification: Student in an Organized Health Care Education/Training Program - 390200000X
Entity Type: Individual

PECOS Registration: Yes

Address:
102 E RAVINE RD
KINGSPORT, TN
ZIP 37660
Phone: (423) 245-9600
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Jack Larsen is a student in an organized health care education training program in Kingsport, TN. The provider is an individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. Jack Larsen NPI is 1972063444. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

102 E RAVINE RD
KINGSPORT, TN
ZIP 37660-814
Phone: (423) 245-9600

The NPI 1972063444 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 3/21/2019 and was last updated on 9/13/2019.

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
1	390200000X	Student in an Organized Health Care Education/Training Program				Yes

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: 11/14/2023

NPI Synchronization or Removal

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