Provider Demographics
NPI:1528444841
Name:HARE, KRISTIN CAMELLE
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:CAMELLE
Last Name:HARE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11245 WILSON RD
Mailing Address - Street 2:TRAILER 24
Mailing Address - City:HENRYETTA
Mailing Address - State:OK
Mailing Address - Zip Code:74437-1604
Mailing Address - Country:US
Mailing Address - Phone:405-786-2204
Mailing Address - Fax:405-786-2625
Practice Address - Street 1:11245 WILSON RD
Practice Address - Street 2:TRAILER 24
Practice Address - City:HENRYETTA
Practice Address - State:OK
Practice Address - Zip Code:74437-1604
Practice Address - Country:US
Practice Address - Phone:405-786-2204
Practice Address - Fax:405-786-2625
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-10
Last Update Date:2015-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care