Larry Keith Vuncannon

Primary specialty

SpecialistTaxonomy code 174400000X

License

PT1052 Issued in MS

Practice address

503 Constitution Dr
Iuka, MS 38852-8201

Phone

(662) 424-9500

Fax

(662) 424-9592

NPI assigned

Jan 31, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MS

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 1991

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Caring Hands Rehab IncGroup PAC ID 9931492543, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Caring Hands Rehab Inc

  • Specialist
  • Iuka, MS
  • NPI 1053458703
  Medicare reassignment Care Compare group Authorized official
• Caring Hands Rehab Inc

  dba Larry K Vuncannon

  • Physical Therapy Clinic/Center
  • Iuka, MS
  • NPI 1215074984
  NPD (past) Authorized official
• Keith Vuncannon & Brad Stephenson PTRS Caring Hands Rehab

  • Physical Therapy Clinic/Center
  • Iuka, MS
  • NPI 1063559755
  Authorized official Same address or phone
• CHR of Booneville, Inc.

  dba Caring Hands Rehab

  • Physical Therapy Clinic/Center
  • Booneville, MS
  • NPI 1992941165
  NPD (past)

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

{
    "created_epoch": "1170201600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1609913466",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "503 CONSTITUTION DR",
            "city": "IUKA",
            "state": "MS",
            "postal_code": "388528201",
            "telephone_number": "662-424-9500",
            "fax_number": "662-424-9592"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "503 CONSTITUTION DR",
            "city": "IUKA",
            "state": "MS",
            "postal_code": "388528201",
            "telephone_number": "662-424-9500",
            "fax_number": "662-424-9592"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VUNCANNON",
        "first_name": "LARRY",
        "middle_name": "KEITH",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-31",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "MS",
            "license": "PT1052",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00119836",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sandra Travis, CMHT
• Wendy J. Trickey, MSN, FNP-C
• Deanna Marie Underwood, CCC-SLP
• Jamie Leigh Vanderford, RN
• Ashli Richardson Vandiver
• Wal-Mart Stores East LP (Walmart Pharmacy 10-0274)
• Marcia Lynn Washington
• Wellness & Clinical Solutions LLC (Avalon Medical Clinic)
• Abby White, SLP
• Angie Michelle Whitehurst, CFNP

• Specialist in Iuka, MS
• Providers in Iuka, MS by specialty
• Specialist in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.