Provider Demographics
NPI:1104251990
Name:LARSON, KIRSTEN D (ANP)
Entity type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:D
Last Name:LARSON
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2730 W STONEBLUFF DR
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-9442
Mailing Address - Country:US
Mailing Address - Phone:907-232-8899
Mailing Address - Fax:
Practice Address - Street 1:2730 W STONEBLUFF DR
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-9442
Practice Address - Country:US
Practice Address - Phone:907-232-8899
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-11
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1388363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1597545Medicaid
AKK165272Medicare PIN