Basic Information
| Provider Information | |||||||||
| NPI: | 1013354018 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LARSEN | ||||||||
| FirstName: | KENDRA | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | FNP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 5010 | ||||||||
| Address2: | |||||||||
| City: | MINOT | ||||||||
| State: | ND | ||||||||
| PostalCode: | 587025010 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7018575650 | ||||||||
| FaxNumber: | 7018575031 | ||||||||
| Practice Location | |||||||||
| Address1: | 111 W. 1ST STREET | ||||||||
| Address2: | TRINITY COMMUNITY CLINIC-VELVA | ||||||||
| City: | VELVA | ||||||||
| State: | ND | ||||||||
| PostalCode: | 587900070 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7013382066 | ||||||||
| FaxNumber: | 7013382048 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/30/2013 | ||||||||
| LastUpdateDate: | 06/25/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/25/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | R29381 | ND | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363L00000X | R29381 | ND | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.