Provider Demographics
NPI:1780129775
Name:LARSEN-VANSANT, KIRSTEN MAUREEN (NP)
Entity type:Individual
Prefix:MRS
First Name:KIRSTEN
Middle Name:MAUREEN
Last Name:LARSEN-VANSANT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2030 LAY DAM RD
Mailing Address - Street 2:
Mailing Address - City:CLANTON
Mailing Address - State:AL
Mailing Address - Zip Code:35045-8344
Mailing Address - Country:US
Mailing Address - Phone:205-663-5775
Mailing Address - Fax:205-739-2049
Practice Address - Street 1:1022 1ST ST N STE 500
Practice Address - Street 2:
Practice Address - City:ALABASTER
Practice Address - State:AL
Practice Address - Zip Code:35007
Practice Address - Country:US
Practice Address - Phone:205-663-5775
Practice Address - Fax:205-664-2112
Is Sole Proprietor?:No
Enumeration Date:2016-12-29
Last Update Date:2018-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN145892363LF0000X
LAAP09088363LF0000X
AL1-143492363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily