Provider Demographics
NPI:1255516969
Name:HARE, CAROLYN (ARNP)
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:
Last Name:HARE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 RINGGOLD RD
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:KY
Mailing Address - Zip Code:42503-3900
Mailing Address - Country:US
Mailing Address - Phone:606-451-1936
Mailing Address - Fax:270-651-1805
Practice Address - Street 1:321 RINGGOLD RD
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42503-3900
Practice Address - Country:US
Practice Address - Phone:606-451-1936
Practice Address - Fax:270-651-1805
Is Sole Proprietor?:No
Enumeration Date:2008-01-02
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY5451P363L00000X, 363LA2200X, 363LP2300X
KY3005451363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYK095672OtherMEDICARE NUMBER
KY7100042070Medicaid