Healthcare Provider Details

I. General information

NPI: 1083560155
Provider Name (Legal Business Name): JESSICA HARE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2026
Last Update Date: 03/10/2026
Certification Date: 03/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

251 N BAYOU ST
MOBILE AL
36603-5827
US

IV. Provider business mailing address

PO BOX 14
JAY FL
32565-0014
US

V. Phone/Fax

Practice location:
  • Phone: 251-690-8158
  • Fax:
Mailing address:
  • Phone: 251-445-9400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LS0200X
TaxonomySchool Nurse Practitioner
License Number1-127477
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: