Keith Larson Neurology PLLC

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

License

22693 Issued in MN

Legal business name

KEITH LARSON NEUROLOGY PLLC

Practice address

1511 Northway Dr
Suite 202
Saint Cloud, MN 56303-1261

Phone

(320) 217-8880

Fax

(320) 253-1822

NPI assigned

Sep 10, 2009

Organization subpart

No

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

Authorized official

Name

Dr. Keith Darryl Larson, M.D.

Title

President

Phone

(320) 217-8880

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1252540800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1252540800000",
    "number": "1982937827",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1511 NORTHWAY DR",
            "address_2": "SUITE 202",
            "city": "SAINT CLOUD",
            "state": "MN",
            "postal_code": "563031261",
            "telephone_number": "320-217-8880",
            "fax_number": "320-253-1822"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1511 NORTHWAY DR",
            "address_2": "SUITE 202",
            "city": "SAINT CLOUD",
            "state": "MN",
            "postal_code": "563031261",
            "telephone_number": "320-217-8880",
            "fax_number": "320-253-1822"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KEITH LARSON NEUROLOGY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-09-10",
        "last_updated": "2009-09-10",
        "status": "A",
        "authorized_official_last_name": "LARSON",
        "authorized_official_first_name": "KEITH",
        "authorized_official_middle_name": "DARRYL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "320-217-8880",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "MN",
            "license": "22693",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mary Lynn Keeler
• Jennifer Marie Keena, LICSW
• Alissa Caroline Keene, PHARM.D
• Amanda Keene
• Jeffrey L Kehl, RRT
• Julie Ann Keller Dornbusch, APRN
• Elissa Keller, RBT
• Crystal Amanda Kelley
• Jennifer Blanca Kelley, MS., IN MFT
• Leslie Marie Kellor-Wentland

• Clinic/Center in Saint Cloud, MN
• Providers in Saint Cloud, MN by specialty
• Clinic/Center in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2009; 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.