Provider Demographics
NPI:1649245440
Name:LARY, EFFIE E (PA-C)
Entity Type:Individual
Prefix:
First Name:EFFIE
Middle Name:E
Last Name:LARY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:EFFIE
Other - Middle Name:
Other - Last Name:BURK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:200 TRENT DR # 1B1C
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27710-8568
Mailing Address - Country:US
Mailing Address - Phone:919-684-7777
Mailing Address - Fax:919-385-9353
Practice Address - Street 1:210 E GRAY ST STE 1105
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-3907
Practice Address - Country:US
Practice Address - Phone:502-583-1697
Practice Address - Fax:919-385-9353
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9102536363A00000X
VA0110007853363A00000X
KYTC079363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLQ03077Medicare UPIN
FLU1649XMedicare UPIN
FLU1649YMedicare NSC