| Doctor Name: | MR. LARRY RAY KENNON |
| NPI Number: | 1003803370 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | APRN, BC |
| License Number: | 061052 |
| Business Practice Address: | 1137 Independence Dr West Plains, MO - 657754221 |
| Business Phone Number: | 4172558464 |
| Business Fax Number: | |
| Mailing Address: | 7232 County Road 9900, WEST PLAINS |
| State: | MO |
| Postal Code: | 657756797 |
| Phone Number: | 4172559233 |
| Fax Number: | |
| NPI Enumeration Date: | 10/03/2005 |
| NPI Last Update Date: | 07/22/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 061052 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MO |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |