Provider Demographics
NPI:1366701955
Name:LARSEN, KATELYN ELIZABETH (PA-C)
Entity type:Individual
Prefix:MRS
First Name:KATELYN
Middle Name:ELIZABETH
Last Name:LARSEN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:KATELYN
Other - Middle Name:ELIZABETH
Other - Last Name:CROUCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:808 EAST PIERCE STREET
Mailing Address - Street 2:
Mailing Address - City:COUNCIL BLUFFS
Mailing Address - State:IA
Mailing Address - Zip Code:51503-4652
Mailing Address - Country:US
Mailing Address - Phone:712-396-4340
Mailing Address - Fax:712-396-4180
Practice Address - Street 1:201 RIDGE ST
Practice Address - Street 2:SUITE 201
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51503-4643
Practice Address - Country:US
Practice Address - Phone:712-322-5899
Practice Address - Fax:712-322-5730
Is Sole Proprietor?:No
Enumeration Date:2012-05-16
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant