Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | 3009296 | KY |
NPI | 1023496817 |
---|---|
Provider Name | Larissa Spurgeon |
First Address | Lexington, KY 40515-4706 |
Second Address | Lexington, KY 40536-0001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/05/2015 |
Last Update Date | 12/05/2015 |