Provider Demographics
NPI:1114086584
Name:HARE, LAURA J (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:J
Last Name:HARE
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 RUSSELL STREET,
Mailing Address - Street 2:SUITE 3
Mailing Address - City:STARKVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39759-3613
Mailing Address - Country:US
Mailing Address - Phone:662-324-2244
Mailing Address - Fax:662-324-2295
Practice Address - Street 1:500 RUSSELL ST
Practice Address - Street 2:SUITE 3
Practice Address - City:STARKVILLE
Practice Address - State:MS
Practice Address - Zip Code:39759-3413
Practice Address - Country:US
Practice Address - Phone:662-324-2244
Practice Address - Fax:662-324-2295
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2014-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR737881363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00118665Medicaid
MS500002092Medicare PIN
MS00118665Medicaid