Provider Demographics
NPI:1689987042
Name:PIERCE, LARRY S JR (PA-C)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:S
Last Name:PIERCE
Suffix:JR
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 RESEARCH DR
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66503-3049
Mailing Address - Country:US
Mailing Address - Phone:785-539-4644
Mailing Address - Fax:785-539-8010
Practice Address - Street 1:2900 AMHERST AVE STE A
Practice Address - Street 2:
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66503-3046
Practice Address - Country:US
Practice Address - Phone:785-239-4411
Practice Address - Fax:785-239-7364
Is Sole Proprietor?:No
Enumeration Date:2010-07-14
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363AM0700X
KS15-02303363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical