Individual provider Active NPI

Amanda Larson, CPNP-PC

  • Pediatric Nurse Practitioner
  • Le Mars, IA
National Provider Identifier
1457745986
Registry record updated Jun 25, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Nurse PractitionerTaxonomy code 363LP0200X
License
C107295 Issued in IA
Practice address
420 12TH St SE
Apt 16
Le Mars, IA 51031-2800
Phone
(712) 541-1401
NPI assigned
Mar 23, 2015
Last updated
Jun 25, 2015By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 25, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Nurse Practitioner 363LP0200X C107295 IA Primary

Addresses

Primary practice location

420 12TH St SE
Apt 16
Le Mars, IA 51031-2800

Mailing address

420 12TH St SE
Apt 16
Le Mars, IA 51031-2800
Phone (712) 541-1401

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250228000719 TX Practitioner - Nurse Practitioner 2961720982 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
C107295IAMDPediatric Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Omaha Tribe of Nebraska CurrentSince Jan 1, 2025 Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1427068800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1435190400000",
    "number": "1457745986",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "420 12TH ST SE",
            "address_2": "APT 16",
            "city": "LE MARS",
            "state": "IA",
            "postal_code": "510312800",
            "telephone_number": "712-541-1401"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "420 12TH ST SE",
            "address_2": "APT 16",
            "city": "LE MARS",
            "state": "IA",
            "postal_code": "510312800",
            "telephone_number": "712-541-1401"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LARSON",
        "first_name": "AMANDA",
        "credential": "CPNP-PC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-03-23",
        "last_updated": "2015-06-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "IA",
            "license": "C107295",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Le Mars, IA

Sources for this page

Verify at the official NPI Registry.