Jacob Alexander Larison, FNP-C

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

RN299713 Issued in GA

Practice address

115 Genevieve CT
Peachtree City, GA 30269-4803

Phone

(682) 216-9595

NPI assigned

Apr 22, 2022

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1650585600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1706486400000",
    "number": "1467196782",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "34 CHERRY TREE BND",
            "city": "NEWNAN",
            "state": "GA",
            "postal_code": "302652602",
            "telephone_number": "682-216-9595"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "115 GENEVIEVE CT",
            "city": "PEACHTREE CITY",
            "state": "GA",
            "postal_code": "302694803",
            "telephone_number": "682-216-9595"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "115 Oak Hill Blvd # 100",
            "address_purpose": "LOCATION",
            "city": "Newnan",
            "state": "GA",
            "postal_code": "302652592",
            "country_code": "US",
            "telephone_number": "682-216-9595",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LARISON",
        "first_name": "JACOB",
        "middle_name": "ALEXANDER",
        "credential": "FNP-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-04-22",
        "last_updated": "2024-01-29",
        "certification_date": "2024-01-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "GA",
            "license": "RN299713",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "GA",
            "license": "RN299713",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Betty Susan Lane, PHD, MSN, BSN, FNP
• Teresa Kay Lane, RN, MSN, CPNP
• Timothy Stanley Lane, M.DIV. AND D.MIN.
• William David Lane, PH.D.
• Rebecca Block Lapidus, PH.D.
• Robin Elizabeth Lasseter, NCC, LAPC
• Mike Latella, CADC-II
• Losheilah Lawrence, PT
• Ann Saracini Layman, O.D.
• Phuong Binh Le, MD

• Family Nurse Practitioner in Peachtree City, GA
• Providers in Peachtree City, GA by specialty
• Family Nurse Practitioner in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.