Provider Demographics
NPI:1154655058
Name:LARSON, KARA DUNBAR (MSPAS, PA-C)
Entity Type:Individual
Prefix:MRS
First Name:KARA
Middle Name:DUNBAR
Last Name:LARSON
Suffix:
Gender:F
Credentials:MSPAS, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8053 SHADOW OAK DR
Mailing Address - Street 2:
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29406-9576
Mailing Address - Country:US
Mailing Address - Phone:864-770-5903
Mailing Address - Fax:
Practice Address - Street 1:8091 RIVERS AVE
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-9236
Practice Address - Country:US
Practice Address - Phone:843-572-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-24
Last Update Date:2009-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCTL1451363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant