Mark Wayne Larsen, MSN-E, FNP-C, CEN
Individual provider Active NPI Family Nurse Practitioner · Afton, WY
NPI 1689166266 · NPPES record last updated May 31, 2018
Key facts
- NPI
- 1689166266
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- 1758.1758 (WY)
- Practice address
- 901 Adams St
Afton, WY 83110-9621 - Phone
- (885) 885-5800
- NPI assigned
- May 31, 2018
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WY
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20180724000964 | WY | Practitioner - Nurse Practitioner | 8325395296 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1758.1758 | WY | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| North Lincoln County Hospital District | Current |
Accepting new patients | |
| North Lincoln County Hospital District | Current |
Accepting new patients |
Locations
901 Adams St
Afton, WY 83110
Phone (307) 885-5800
110 Hospital Ln
Afton, WY 83110
Phone (208) 227-1137
Interoperability endpoints
- mlarsen624947@direct.ochin.org
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 1758.1758 | WY | Yes |
Addresses
Primary practice location
901 Adams St
Afton, WY 83110-9621
Mailing address
585 W 7615 S
Willard, UT 84340-9525
Phone (435) 979-7546
Other providers in Afton, WY
- Cache D Kennington
- William H Kennington
- Brenda Ellen Kentner
- Delphine Rossi Knowlton
- Devon Kuhlman
- Jordan K Lee
- Reed Lesuma
- Taylor Marie Lewis
- Lincoln Self Reliance, Inc.
- Lincoln Self Reliance, Inc.
All providers in Afton, WY · Family Nurse Practitioner in Wyoming
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 31, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.