Provider Demographics
NPI:1467447896
Name:LARNER, DOUGLAS SCOTT (NP)
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:SCOTT
Last Name:LARNER
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:892 W S BOULDER RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:CO
Mailing Address - Zip Code:80027-2453
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:892 W S BOULDER RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:CO
Practice Address - Zip Code:80027-2453
Practice Address - Country:US
Practice Address - Phone:303-666-7717
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-12
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0992720-NP163WP0000X, 2081P2900X, 363L00000X
TNAPN0000010682363LA2200X
CA95013876363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WP0000XNursing Service ProvidersRegistered NursePain Management
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAH-117510OtherSTATE LICENSE
VA1467447896Medicaid
TN36481133Medicaid
TN4129710OtherBC/BS OF TN - MCMINNVILLE
TN4152193OtherBC/BS OF TN - KINGSPORT
IAH-117510OtherSTATE LICENSE
TN2593150Medicare PIN
TN36481132Medicare PIN
TN4139078OtherBC/BS OF TN - LAWRENCEBURG
TNAPN0000010682OtherSTATE LICENSE
TNP00326253OtherRAILROAD MEDICARE - LEBANON
VA015995C01Medicare PIN
TN3648115Medicaid
NC0050-03624OtherSTATE LICENSE
TN4139727OtherBC/BS OF TN - CROSSVILLE
TN36481132Medicaid
VA0024167346OtherSTATE LICENSE
TN4126548OtherBC/BS OF TN - COLUMBIA
TN4138882OtherBC/BS OF TN - WINCHESTER
TN3648114Medicare PIN