Active NPI
James Robert Larsen Jr., A.T.C. L.A.T.
- Athletic Trainer
- Powell, WY
National Provider Identifier
1669741724
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 011
- Practice address
- 387 N Ferris St
Apt L
Powell, WY 82435-2042 - Phone
- (307) 359-0617
- NPI assigned
- Dec 19, 2011
- 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 |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | 011 | WY | Primary |
Addresses
Primary practice location
387 N Ferris St
Apt L
Powell, WY 82435-2042
Mailing address
387 N Ferris St
Apt L
Powell, WY 82435-2042
Phone (307) 359-0617
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 011 | WY | MD | Midwife |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1324252800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1324252800000",
"number": "1669741724",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "387 N FERRIS ST",
"address_2": "APT L",
"city": "POWELL",
"state": "WY",
"postal_code": "824352042",
"telephone_number": "307-359-0617"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "387 N FERRIS ST",
"address_2": "APT L",
"city": "POWELL",
"state": "WY",
"postal_code": "824352042",
"telephone_number": "307-359-0617"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LARSEN",
"first_name": "JAMES",
"middle_name": "ROBERT",
"name_prefix": "Mr.",
"name_suffix": "Jr.",
"credential": "A.T.C. L.A.T.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-12-19",
"last_updated": "2011-12-19",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "WY",
"license": "011",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Powell, WY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.