MISS MALLORY CHRISTINE LARSEN (NPI# 1255780656) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1255780656 |
| Entity Type | Individual |
| Full Name | MISS MALLORY CHRISTINE LARSEN |
| Credential | PA-C |
| Practice Address |
5330 E Stop 11 Rd Indianapolis IN 46237-6345 |
| Mailing Address |
Po Box 781076 Detroit MI 48278-1076 |
| Practice Telephone | 3178931900 |
| Practice Fax Number | 3178931901 |
| Mailing Telephone | 3175284800 |
| Mailing Fax Number | 3178651479 |
| Enumeration Date | 2016-06-07 |
| Last Update Date | 2018-12-03 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AM0700X |
Physician Assistant Specialization: Medical |
10002066A | IN | Physician Assistants & Advanced Practice Nursing Providers |
| N | 363AM0700X |
Physician Assistant Specialization: Medical |
IN | Physician Assistants & Advanced Practice Nursing Providers |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 1402 E County Line Rd, Indianapolis, IN 462270963 | 3178877000 | |
| 5330 E Stop 11 Rd, Indianapolis, IN 462376345 | 3178931900 | 3178931901 |
| Street Address |
5330 E STOP 11 RD |
| City | INDIANAPOLIS |
| State | IN |
| Zip Code | 46237-6345 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487651329 | Louis F. Janeira | Internal Medicine | 5330 E Stop 11 Rd, Indianapolis, IN 46237-6345 | 2005-07-07 |
| 1912542630 | Leanne Nichole Davis | Physician Assistant | 5330 E Stop 11 Rd, Indianapolis, IN 46237-6345 | 2019-11-18 |
| 1770126864 | Rachel Nicole Peterson | Physician Assistant | 5330 E Stop 11 Rd, Indianapolis, IN 46237-6345 | 2019-10-22 |
| 1215491261 | Raven P Cox | Registered Nurse | 5330 E Stop 11 Rd, Indianapolis, IN 46237-6345 | 2019-01-24 |
| 1528583606 | Lynda Jean Yousif | Physician Assistant | 5330 E Stop 11 Rd, Indianapolis, IN 46237 | 2017-08-09 |
| 1801337761 | Andra L. Meyers | Registered Nurse | 5330 E Stop 11 Rd, Indianapolis, IN 46237-6345 | 2017-03-13 |
| 1255707667 | Angie Howald | Nurse Practitioner | 5330 E Stop 11 Rd, Indianapolis, IN 46237-6345 | 2015-08-19 |
| 1689009441 | Casey Nicole Browning | Nurse Practitioner | 5330 E Stop 11 Rd, Indianapolis, IN 46237-6345 | 2013-09-11 |
| 1811333941 | George Lolay | Internal Medicine | 5330 E Stop 11 Rd, Indianapolis, IN 46237-6345 | 2013-05-15 |
| 1700151057 | Shenil Shah | Internal Medicine | 5330 E Stop 11 Rd, Indianapolis, IN 46237 | 2012-03-20 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568961902 | Ashley Marie Mitchell | Nurse Practitioner | 8111 S Emerson Ave # 101, Indianapolis, IN 46237 | 2018-02-11 |
| 1245692177 | Christopher W Gregory | Pharmacist | 8111 S Emerson Avenue, Indianapolis, IN 46237 | 2016-03-21 |
| 1558729111 | Franklin Point Dental | Clinic/Center | 6751 E Southport Rd, Suite H, Indianapolis, IN 46237 | 2016-02-10 |
| 1821460767 | Costco Wholesale Corporation | Pharmacy | 4628 E County Line Rd, Indianapolis, IN 46237 | 2015-10-29 |
| 1164894697 | Mercedes Castellanos-pitcock | Physician Assistant | 7855 S Emerson Ave Ste P, Indianapolis, IN 46237 | 2015-10-23 |
| 1013301142 | Sophia Frawley | Physical Therapist | 7855 South Emerson Avenue, Suite W, Indianepolis, IN 46237 | 2015-03-26 |
| 1154715829 | Emily Marie Prather | Specialist/Technologist | 4607 Citation Cir, Indianapolis, IN 46237 | 2015-03-20 |
| 1659794543 | Rachel Adams | Occupational Therapy Assistant | 6525 Moss Creek Place, Indianapolis, IN 46237 | 2014-01-28 |
| 1790121549 | Carol Lynn Patton | Nurse Practitioner | 8111 S Emerson Ave Fl 5, Indianapolis, IN 46237 | 2013-05-21 |
| 1255685772 | Jarron J Lincoln | Physician Assistant | 5230 E Stop 11 Rd Ste 250, Indianapolis, IN 46237 | 2012-11-06 |
| Find all providers in zip 46237 | ||||
| Taxonomy Code | 363AM0700X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Medical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124634936 | Brilyn Michelle Banister | Physician Assistant | 8443 Cabin Creek Dr Apt G, Indianapolis, IN 46237-6330 | 2020-09-17 |
| 1386290625 | Douglas R Day | Physician Assistant | 1701 N Senate Blvd # Ag373a, Indianapolis, IN 46202-1239 | 2019-08-13 |
| 1841851409 | Rachel Jagrowski | Physician Assistant | 1801 N Senate Blvd Ste 700, Indianapolis, IN 46202-1177 | 2019-06-25 |
| 1407311814 | William Peter Thompson | Physician Assistant | 1801 N Capitol Ave # Npe120, Indianapolis, IN 46202-1217 | 2019-02-11 |
| 1912492679 | Katherine Barrett Tenbarge | Physician Assistant | 1800 N Capitol Ave # E140, Indianapolis, IN 46202-1218 | 2018-06-26 |
| 1154843704 | Jennifer Trapuzzano | Physician Assistant | 1801 N Senate Blvd Ste 310, Indianapolis, IN 46202-1196 | 2017-07-14 |
| 1154879666 | Grace Schultz | Physician Assistant | 1408 Broadway St Apt F, Indianapolis, IN 46202-2744 | 2016-09-13 |
| 1477925071 | Samantha Kitcoff | Physician Assistant | 8180 Clearvista Pkwy Ste 100, Indianapolis, IN 46256 | 2015-10-22 |
| 1386040046 | Maham Mushtaq | Physician Assistant | 5759 James Blair Dr, Indianapolis, IN 46234-3226 | 2014-11-07 |
| 1285030924 | Margaret Anne Voelker-park | Physician Assistant | 550 University Blvd Unit 3240, Indianapolis, IN 46202-5250 | 2014-11-07 |
| Find all providers in INDIANAPOLIS | ||||
| City | INDIANAPOLIS |
| Zip Code | 46237 |
Please comment or provide details below to improve the information on MISS MALLORY CHRISTINE LARSEN.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.