Most Relevant Information
Provider Data
| NPI Number: | 1003803370 |
| Provider Name: | LARRY RAY KENNON APRN, BC |
| Entity Type: | Individual |
| Taxonomy Code: | 363LF0000X |
| Specialty: | Nurse Practitioner |
| License Number: | 061052 |
Most Important Dates
| Enumeration Date: | 10/03/2005 |
| Last Updated: | 07/22/2013 |
Provider Practice Location
1137 INDEPENDENCE DR
WEST PLAINS
MO
657754221
Practice Location Phone/Fax
| Phone: | 4172558464 |
| Fax: |
Provider Mailing Location
7232 COUNTY ROAD 9900
WEST PLAINS
MO
657756797
Provider Mailing Phone/Fax
| Phone: | 4172559233 |
| Fax: |