Active NPI
Larry Everett Hamner, PA-C
- Physician Assistant
- Albuquerque, NM
National Provider Identifier
1306911243
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA-04
- Practice address
- 8324 Constitution PL NE
Albuquerque, NM 87110-7651 - Phone
- (505) 293-8000
- Fax
- (505) 293-8004
- NPI assigned
- Nov 22, 2006
- Last updated
- Sep 9, 2008
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA-04 | NM | Primary |
Addresses
Primary practice location
8324 Constitution PL NE
Albuquerque, NM 87110-7651
Mailing address
8324 Constitution PL NE
Albuquerque, NM 87110-7651
Phone (505) 293-8000
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 94557 | Medicaid | NM | |
| PA-04 | Other | NM | STATE LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA-04 | NM | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1164153600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1220918400000",
"number": "1306911243",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8324 CONSTITUTION PL NE",
"city": "ALBUQUERQUE",
"state": "NM",
"postal_code": "871107651",
"telephone_number": "505-293-8000",
"fax_number": "505-293-8004"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8324 CONSTITUTION PL NE",
"city": "ALBUQUERQUE",
"state": "NM",
"postal_code": "871107651",
"telephone_number": "505-293-8000",
"fax_number": "505-293-8004"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HAMNER",
"first_name": "LARRY",
"middle_name": "EVERETT",
"name_prefix": "Mr.",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-11-22",
"last_updated": "2008-09-09",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "NM",
"license": "PA-04",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "94557",
"state": "NM"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE LICENSE",
"identifier": "PA-04",
"state": "NM"
}
],
"endpoints": [],
"other_names": []
}Other providers in Albuquerque, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.