BRENNEN LARSEN (NPI# 1740659010) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1740659010 |
| Entity Type | Individual |
| Full Name | BRENNEN LARSEN |
| Credential | PA-C |
| Practice Address |
21 Winn Dr Rexburg ID 83440-5277 |
| Practice Telephone | 2088815222 |
| Practice Fax Number | 8774414715 |
| Mailing Telephone | 2088815222 |
| Mailing Fax Number | 8874414715 |
| Enumeration Date | 2015-09-17 |
| Last Update Date | 2019-11-19 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | 6141 | AZ | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
21 WINN DR |
| City | REXBURG |
| State | ID |
| Zip Code | 83440-5277 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114957362 | Kelly L Dustin | Family Medicine | 21 Winn Dr, Rexburg, ID 83440-5277 | 2006-07-04 |
| 1457698987 | Fall River Medical, Pllc | Clinic/Center | 21 Winn Dr, Rexburg, ID 83440 | 2013-01-03 |
| 1083810287 | Austin C Gillette | Family Medicine | 21 Winn Dr, Rexburg, ID 83440-5277 | 2007-06-25 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235768490 | Henry's Fork Surgery Center Pllc | Clinic/Center | 23 Sawtelle Ave, Rexburg, ID 83440 | 2020-04-08 |
| 1952956906 | Shane Ellis Withers | Pharmacist | 164 E. Main, Rexburg, ID 83440 | 2019-08-06 |
| 1316392285 | Emma Anderson | Speech-Language Pathologist | 36 Professional Plaza Suite 110, Rexburg, ID 83440 | 2016-04-28 |
| 1851755524 | Sandra Frickey | Speech-Language Pathologist | 1087 Summers Drive, Premier Therapy Associates, Rexburg, ID 83440 | 2016-04-08 |
| 1275997215 | Kerry Denney | Counselor | 333 Walker Drive, Rexburg, ID 83440 | 2016-04-06 |
| 1467837583 | Wal-mart Stores, Inc. | Technician/Technologist | 303 E Moody Rd, Rexburg, ID 83440 | 2015-07-30 |
| 1649692609 | Tanabell Health Services, Inc. | Skilled Nursing Facility | 410 W 1st N, Rexburg, ID 83440 | 2014-01-10 |
| 1043652571 | Creed Simon Webster | Counselor | 30 S 2nd W, Rexburg, ID 83440 | 2013-07-25 |
| 1033461660 | James Cannon Allen Dds PC | Dentist | 106 E 1st North, Rexburg, ID 83440 | 2012-10-05 |
| 1417217316 | Shelby Dee Woolstenhulme | Speech-Language Pathologist | 450 E. Main Street, Rexburg, ID 83440 | 2012-05-24 |
| Find all providers in zip 83440 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700278553 | Chad W Hurd | Physician Assistant | 375 S 5000 W, Rexburg, ID 83440-3693 | 2015-03-02 |
| 1962585752 | Travis J Weiszhaar | Physician Assistant | 1 Professional Plz, Rexburg, ID 83440-2024 | 2006-10-23 |
| 1528097102 | Terry J. Anderson | Physician Assistant | 100 Shc Drive Byui, Rexburg, ID 83460-2010 | 2006-07-03 |
| 1962438812 | Dan Loren Weber | Physician Assistant | 256 N 2nd E, Rexburg, ID 83440-1638 | 2006-06-23 |
| 1366488926 | Trent E Shaw | Physician Assistant | 72 E Main St, Rexburg, ID 83440-1926 | 2006-06-21 |
| 1669897989 | Bryant Hansen | Physician Assistant | 72 S 1st E, Rexburg, ID 83440-1902 | 2014-02-24 |
| 1003257478 | Dave Robinson | Physician Assistant | 1236 Bond Ave Ste B, Rexburg, ID 83440 | 2013-07-12 |
| 1518212265 | David Porter Batt | Physician Assistant | 393 E 2nd N, Rexburg, ID 83440-1605 | 2012-07-18 |
| 1154618601 | Rebecca L Perez | Physician Assistant | 393 E 2nd N, Rexburg, ID 83440-1605 | 2011-07-06 |
| 1558445932 | Nichole Robson | Physician Assistant | 1 Professional Plz, Rexburg, ID 83440-2024 | 2006-10-24 |
| Find all providers in REXBURG | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.