Provider Demographics
NPI:1205876802
Name:LARSON, JUDY K (CRNA)
Entity type:Individual
Prefix:
First Name:JUDY
Middle Name:K
Last Name:LARSON
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:241 WHISPERING LN
Mailing Address - Street 2:
Mailing Address - City:MADISONVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70447-9348
Mailing Address - Country:US
Mailing Address - Phone:985-792-4660
Mailing Address - Fax:
Practice Address - Street 1:LALLIE KEMP HOSPITAL
Practice Address - Street 2:52579 HIGHWAY 51 SOUTH
Practice Address - City:INDEPENDENCE
Practice Address - State:LA
Practice Address - Zip Code:70443
Practice Address - Country:US
Practice Address - Phone:985-878-9421
Practice Address - Fax:985-878-1431
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA01461367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered