Provider Demographics
NPI:1124393095
Name:LARKIN, MALLORY E (PA)
Entity Type:Individual
Prefix:
First Name:MALLORY
Middle Name:E
Last Name:LARKIN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:MALLORY
Other - Middle Name:E
Other - Last Name:HELTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:325 MAINE ST
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66044-1360
Mailing Address - Country:US
Mailing Address - Phone:785-505-2988
Mailing Address - Fax:
Practice Address - Street 1:6265 ROCK CHALK DR STE 1500
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66049-5232
Practice Address - Country:US
Practice Address - Phone:785-843-9125
Practice Address - Fax:785-505-5312
Is Sole Proprietor?:No
Enumeration Date:2012-03-12
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPA156716363AS0400X
KS15-01709363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS30004345940001Medicaid
KS15-01709OtherSTATE LICENSE
ORPA156716OtherSTATE LICENSE