Provider Demographics
NPI:1790664399
Name:LANFORD, ASHLYN LARSEN
Entity type:Individual
Prefix:
First Name:ASHLYN
Middle Name:LARSEN
Last Name:LANFORD
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:ASHLYN
Other - Middle Name:LEE
Other - Last Name:LARSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:127 CEDAR SWAMP RD
Mailing Address - Street 2:
Mailing Address - City:TOLLAND
Mailing Address - State:CT
Mailing Address - Zip Code:06084-3611
Mailing Address - Country:US
Mailing Address - Phone:860-874-8866
Mailing Address - Fax:
Practice Address - Street 1:6965 CUMBERLAND GAP PKWY
Practice Address - Street 2:
Practice Address - City:HARROGATE
Practice Address - State:TN
Practice Address - Zip Code:37752-8245
Practice Address - Country:US
Practice Address - Phone:423-869-3611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-28
Last Update Date:2025-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant