Provider Demographics
NPI:1013545128
Name:ADAIR, SARA JANE (RN,BSN)
Entity Type:Individual
Prefix:MS
First Name:SARA
Middle Name:JANE
Last Name:ADAIR
Suffix:
Gender:F
Credentials:RN,BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14812 NASSAU DR
Mailing Address - Street 2:
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39532-5713
Mailing Address - Country:US
Mailing Address - Phone:228-697-6238
Mailing Address - Fax:
Practice Address - Street 1:330B HIGHWAY 90
Practice Address - Street 2:
Practice Address - City:GAUTIER
Practice Address - State:MS
Practice Address - Zip Code:39553-5744
Practice Address - Country:US
Practice Address - Phone:228-497-0434
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-01
Last Update Date:2020-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR864450163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00018214Medicaid