Provider Demographics
NPI:1659025005
Name:LARSEN, KAYLA RAE (LPN)
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:RAE
Last Name:LARSEN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:KAYLA
Other - Middle Name:RAE
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:18 BREWSTER LN
Mailing Address - Street 2:
Mailing Address - City:BIRNEY
Mailing Address - State:MT
Mailing Address - Zip Code:59012-9502
Mailing Address - Country:US
Mailing Address - Phone:307-752-1983
Mailing Address - Fax:
Practice Address - Street 1:1898 FORT RD
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:WY
Practice Address - Zip Code:82801-8320
Practice Address - Country:US
Practice Address - Phone:307-672-3473
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-04
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY8545164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse