Basic Information
| Provider Information | |||||||||
| NPI: | 1407838311 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LARKIN | ||||||||
| FirstName: | MELLISA | ||||||||
| MiddleName: | L | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | A.R.N.P | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5200 COMMERCE CROSSING, 3RD FLOOR | ||||||||
| Address2: | |||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 40229 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5022534924 | ||||||||
| FaxNumber: | 5024895750 | ||||||||
| Practice Location | |||||||||
| Address1: | 4001 KRESGE WAY | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402074640 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5028976579 | ||||||||
| FaxNumber: | 5028972725 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/16/2005 | ||||||||
| LastUpdateDate: | 12/10/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/10/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 3002601 | KY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 1076667 | 01 | KY | REGISTERED NURSE LICENSE | OTHER | 2601P | 01 | KY | NURSE PRACTITIONER LICENS | OTHER |