Provider Demographics
NPI:1588615868
Name:SCRAPE, SARA J (NP)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:J
Last Name:SCRAPE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 WILLOW BEND DR
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39402-8552
Mailing Address - Country:US
Mailing Address - Phone:601-296-2552
Mailing Address - Fax:601-296-2554
Practice Address - Street 1:9 WILLOW BEND DR
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-8552
Practice Address - Country:US
Practice Address - Phone:601-296-2552
Practice Address - Fax:601-296-2554
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2011-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR718025363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2113445Medicaid
MS04385071Medicaid
MS1180663OtherCIGNA
MSP00791975OtherRAILROAD MEDICARE
MS04385071Medicaid
MS302I501991Medicare PIN