Provider Demographics
NPI:1053191163
Name:O'KEEFE, LARISSA ROSE (FNP-BC)
Entity type:Individual
Prefix:
First Name:LARISSA
Middle Name:ROSE
Last Name:O'KEEFE
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4823 LOYALIST LN
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:MO
Mailing Address - Zip Code:65010-9418
Mailing Address - Country:US
Mailing Address - Phone:573-301-2532
Mailing Address - Fax:
Practice Address - Street 1:200 CORPORATE LAKE DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-7172
Practice Address - Country:US
Practice Address - Phone:573-814-1170
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-05
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2023040439363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care