Larry Lee Bousquet II, FNP
Individual provider Active NPI Nurse Practitioner · Fort Mohave, AZ
NPI 1205544871 · NPPES record last updated Nov 11, 2022
Key facts
- NPI
- 1205544871
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Nurse Practitioner 363L00000X
- License
- 283825 (AZ)
- Practice address
- 1611 E Joy LN # 1
Fort Mohave, AZ 86426-8807 - Phone
- (928) 768-9496
- Fax
- (928) 768-1943
- NPI assigned
- Nov 11, 2022
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Hospital & facility affiliations 6
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2022
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Mohave Family Healthcare
Paragon Physical Therapy and Rehab LLC
Practice addresses (Care Compare)
1611 Joy Lane
Fort Mohave, AZ 86426-8807
Phone (928) 768-9496
2585 Miracle Mile
Suite 107
Bullhead City, AZ 86442-7522
Hospital & facility affiliations
- Valley View Home Health
- River Valley Home Health
- Valley View Medical Center
- Western Arizona Regional Medical Center
- Kingman Regional Medical Center
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AZ
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20230109002573 | AZ | Practitioner - Nurse Practitioner | 6204206204 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 283825 | AZ | MD | Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mohave Family Healthcare | Current |
Accepting new patients |
Locations
1611 E Joy Ln
Ste 1
Fort Mohave, AZ 86426
Phone (757) 251-0879
1611 E Joy Ln
Fort Mohave, AZ 86426
Phone (928) 768-9496
Interoperability endpoints
- https://fhir4.healow.com/fhir/r4/CIAHCD
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 283825 | AZ | Yes |
Addresses
Primary practice location
1611 E Joy LN # 1
Fort Mohave, AZ 86426-8807
Mailing address
1611 E Joy LN
Fort Mohave, AZ 86426-8807
Phone (928) 768-9496
Other providers in Fort Mohave, AZ
- Blue River Health & Wellness, PLLC
- Blue Water Internal Medicine Associates P C
- Scott Irwin Boggs
- Jennifer Booze-Hawkes
- Eric Eugene Borofsky
- Clifford J Bragg
- Melissa Jones Brewer Larson
- Deanna Brocard
- Hector Burgara Jr.
- Kelly T. Buth
All providers in Fort Mohave, AZ · Nurse Practitioner in Arizona
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 11, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.