Provider Demographics
NPI:1225204282
Name:LARSON, ATHENA (NP)
Entity Type:Individual
Prefix:MRS
First Name:ATHENA
Middle Name:
Last Name:LARSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 HOSPITAL DR
Mailing Address - Street 2:SUITE 410
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-2852
Mailing Address - Country:US
Mailing Address - Phone:337-289-9700
Mailing Address - Fax:337-289-9702
Practice Address - Street 1:155 HOSPITAL DR
Practice Address - Street 2:SUITE 410
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-2852
Practice Address - Country:US
Practice Address - Phone:337-289-9700
Practice Address - Fax:337-289-9702
Is Sole Proprietor?:No
Enumeration Date:2008-04-30
Last Update Date:2014-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP04546363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAAP05456OtherLICENSE
LA3A902CN33Medicare PIN