Kennon, Larry Ray

Kennon, Larry Ray is an individual health care provider with primary practice located at 1137 Independence Dr , West Plains MO 65775-4221. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Family, which is considered as his primary health care specialty. Kennon, Larry Ray can be contacted via phone (417) 255-8464.

Contact Information

Primary practice address
1137 Independence Dr West Plains MO 65775-4221
Phone: (417) 255-8464
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X 061052 Missouri

Profile Details

NPI number 1003803370
LBN Legal business name Kennon, Larry Ray
Credentials APRN, BC
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 3rd, 2005
Last updated Jul 22nd, 2013 - about 11 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

Request for update

Identifiers

StateTypeNumberIssuer
All States NPI 1003803370 NPPES
Other 000013700 MEDICARE GROUP NUMBER
Other 261882 MEDICARE GROUP NUMBER
Other 261863 MEDICARE GROUP NUMBER
MEDICAID 428580211 MEDICARE GROUP NUMBER

Popular Providers