Provider Demographics
NPI:1124059530
Name:KERSCHNER, LARRY EUGENE (ARNP)
Entity type:Individual
Prefix:MR
First Name:LARRY
Middle Name:EUGENE
Last Name:KERSCHNER
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 158
Mailing Address - Street 2:402 NORTH MAIN STREET
Mailing Address - City:PE ELL
Mailing Address - State:WA
Mailing Address - Zip Code:98572-0158
Mailing Address - Country:US
Mailing Address - Phone:360-291-3232
Mailing Address - Fax:360-291-3144
Practice Address - Street 1:402 NORTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:PE ELL
Practice Address - State:WA
Practice Address - Zip Code:98572-0158
Practice Address - Country:US
Practice Address - Phone:360-291-3232
Practice Address - Fax:360-291-3144
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2008-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30001759363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA503837Medicare Oscar/Certification