Provider Demographics
NPI:1336540715
Name:WARE, JAMES ROBERT II (NP-C)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:ROBERT
Last Name:WARE
Suffix:II
Gender:M
Credentials:NP-C
Other - Prefix:
Other - First Name:JAMES
Other - Middle Name:R
Other - Last Name:WARE
Other - Suffix:II
Other - Last Name Type:Professional Name
Other - Credentials:NP-C
Mailing Address - Street 1:125 CUMBERLAND RD
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:MS
Mailing Address - Zip Code:39047-6735
Mailing Address - Country:US
Mailing Address - Phone:796-610-6783
Mailing Address - Fax:
Practice Address - Street 1:1225 N STATE ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39202-2064
Practice Address - Country:US
Practice Address - Phone:601-968-4087
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-04
Last Update Date:2014-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR693782363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care