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Larry Keith Vuncannon
Specialist in Iuka, Mississippi
NPI 1609913466

Larry Keith Vuncannon is a Specialist based in Iuka, MS. Larry Keith Vuncannon practices in Iuka, MS. The NPI Number for Larry Keith Vuncannon is 1609913466 and holds a License No. PT1052 (Mississippi).

The current practice location address for Larry Keith Vuncannon is 503 Constitution Dr, Iuka, MS and can be reached out via phone at 662-424-9500 and via fax at 662-424-9592.

Location: 503 Constitution Dr, Iuka, MS, 38852-8201
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1609913466
Provider Name
Larry Keith Vuncannon
Credential
Provider Entity Type
Individual
Gender
Male
Address
503 Constitution Dr, Iuka, MS, 38852-8201
Phone Number
662-424-9500
Fax Number
662-424-9592
Provider Enumeration Date
01/31/2007
Last Update Date
03/08/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
00119836 05 MS
institution
Provider Business Practice Location Address Details
Address
503 Constitution Dr
City
Iuka
State
Mississippi
Zip
38852-8201
Phone Number
662-424-9500
Fax Number
662-424-9592
person
Provider Business Mailing Address Details
Address
503 Constitution Dr
City
Iuka
State
Mississippi
Zip
38852-8201
Phone Number
662-424-9500
Fax Number
662-424-9592
person
Provider's Taxonomy Details 1
Type
Other Service Providers
Classification
Specialist
Speciality
-
Taxonomy
174400000X
License No.
PT1052 (Mississippi)
Definition
An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.
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