Provider Demographics
NPI:1851542682
Name:HUYCKE, LARAE I (PMHNP-ARNP)
Entity type:Individual
Prefix:
First Name:LARAE
Middle Name:I
Last Name:HUYCKE
Suffix:
Gender:F
Credentials:PMHNP-ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4784 OAK ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64112-2262
Mailing Address - Country:US
Mailing Address - Phone:817-991-5951
Mailing Address - Fax:
Practice Address - Street 1:1220 E 8TH ST
Practice Address - Street 2:
Practice Address - City:GALENA
Practice Address - State:KS
Practice Address - Zip Code:66739-1865
Practice Address - Country:US
Practice Address - Phone:417-658-9565
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-10
Last Update Date:2024-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX741234363LP0808X
WAAP61253183363LP0808X
MO2024029050363LP0808X
KS53-83532-101363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8Y8938OtherBLUE CROSS BLUE SHIELD
TX8L6532Medicare PIN