Provider Demographics
NPI:1457686826
Name:NYE, LARRY W (PA-C)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:W
Last Name:NYE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:969 STEVENS DR STE 3A
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-3558
Mailing Address - Country:US
Mailing Address - Phone:509-713-1315
Mailing Address - Fax:866-422-7049
Practice Address - Street 1:969 STEVENS DR STE 3A
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-3558
Practice Address - Country:US
Practice Address - Phone:509-713-1315
Practice Address - Fax:866-422-7049
Is Sole Proprietor?:No
Enumeration Date:2009-10-02
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAPA60102449363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant