Lara Blake
Family Medicine in Tupelo, MS. Individual provider (NPI-1).
NPI number1881472371
StatusActive
Last updated in NPPESSep 18, 2023
Details
- NPI
- 1881472371
- Entity type
- Individual (NPI-1)
- Name
- Lara Blake
- Sex
- Female
- Sole proprietor
- Yes
- Enumeration date
- Sep 18, 2023
- Certification date
- Sep 18, 2023
- Last updated
- Sep 18, 2023
Medicare and OIG
- Medicare enrolled (PECOS)
- Yes · PRACTITIONER - NURSE PRACTITIONER
- Can order and refer
- Part B Yes · DME Yes · Home health Yes · Power mobility Yes · Hospice No
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207Q00000X | Family Medicine | 906281 | MS | Yes |
Practice location
845 S Madison StTupelo, MS 38801-4905
Phone 662-377-3000
Mailing address
2056 New Chapel RdNettleton, MS 38858-8257
Phone 662-538-8753
Is something wrong?
This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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All 79 Family Medicine Physician providers in Tupelo · All 2,880 providers in Tupelo
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