Provider Demographics
NPI:1871964098
Name:LARSEN, JULIA (PMHNP)
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:
Last Name:LARSEN
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 MCKINNEY ST
Mailing Address - Street 2:
Mailing Address - City:FARMERSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75442-2213
Mailing Address - Country:US
Mailing Address - Phone:972-784-3064
Mailing Address - Fax:972-784-3069
Practice Address - Street 1:107 MCKINNEY ST
Practice Address - Street 2:
Practice Address - City:FARMERSVILLE
Practice Address - State:TX
Practice Address - Zip Code:75442-2213
Practice Address - Country:US
Practice Address - Phone:972-784-3064
Practice Address - Fax:972-784-3069
Is Sole Proprietor?:No
Enumeration Date:2015-10-14
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP129335363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX764964OtherRN LICENSE
TXAP129335OtherAPRN LICENSE