Provider Demographics
NPI:1467461038
Name:LARSON, KINDRA ANNE (MD)
Entity Type:Individual
Prefix:DR
First Name:KINDRA
Middle Name:ANNE
Last Name:LARSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 936
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23501-0936
Mailing Address - Country:US
Mailing Address - Phone:757-446-7900
Mailing Address - Fax:757-624-2254
Practice Address - Street 1:825 FAIRFAX AVE
Practice Address - Street 2:SUITE 310
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23507-1914
Practice Address - Country:US
Practice Address - Phone:757-446-7900
Practice Address - Fax:757-624-2254
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2011-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
VA0101247346207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1467461038Medicaid
VA10059924OtherOPTIMA HEALTH
VAPAROtherFIRST HEALTH COMMERCIAL/COVENTRY HEALTH/SOUTHERN HEALTH
VA-010OtherTRICARE/CHAMPUS
VAPAROtherVA PREMIER HEALTH
VAPAROtherUSA MANAGED CARE
VAPAROtherCIGNA
VAPAROtherCORVEL/CORCARE
VAPAROtherMULTIPLAN
VA409628OtherANTHEM BC/BS
VAPAROtherAETNA
VAPAROtherUNITED HEALTH CARE/MAMSI
NC5914944Medicaid
VAPAROtherVA HEALTH NETWORK
VAPAROtherVA HEALTH NETWORK
VA1467461038Medicaid