| Doctor Name: | KIRT W LARSON |
| NPI Number: | 1053576504 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MSN,FNP-C |
| License Number: | 2114514405 |
| Business Practice Address: | 2332 W 12600 S Suite 2c Riverton, UT - 840657161 |
| Business Phone Number: | 8014462760 |
| Business Fax Number: | 8014462762 |
| Mailing Address: | 2332 W 12600 S, Suite 2c RIVERTON |
| State: | UT |
| Postal Code: | 840657161 |
| Phone Number: | 8014462760 |
| Fax Number: | 8014462762 |
| NPI Enumeration Date: | 07/24/2008 |
| NPI Last Update Date: | 07/24/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 2114514405 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | UT |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |