Provider Demographics
NPI:1336800291
Name:LARSON, ELIZABETH KATHERINE (PA-C)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:KATHERINE
Last Name:LARSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:KATHERINE
Other - Last Name:ARNETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:16525 LEXINGTON BLVD STE 140
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-2588
Mailing Address - Country:US
Mailing Address - Phone:713-766-5437
Mailing Address - Fax:
Practice Address - Street 1:16525 LEXINGTON BLVD STE 140
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-2588
Practice Address - Country:US
Practice Address - Phone:713-766-5437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-04
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
TXPA15296363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant