Provider Demographics
NPI:1568000131
Name:OWENS, LARRY M (NRP)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:M
Last Name:OWENS
Suffix:
Gender:M
Credentials:NRP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:168 E REYNOLDS RD STE 130
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40517-1317
Mailing Address - Country:US
Mailing Address - Phone:859-554-5067
Mailing Address - Fax:859-818-0324
Practice Address - Street 1:22 MERCY CT
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:KY
Practice Address - Zip Code:40336-1331
Practice Address - Country:US
Practice Address - Phone:606-723-2124
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-14
Last Update Date:2019-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1019717207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
M5040990OtherNATIONAL REGISTRY OF EMERGENCY MEDICAL TECHNICIANS (NREMT)
KY1019717OtherKY BOARD OF EMERGENCY MEDICAL SERVICES