Provider Demographics
NPI:1063637031
Name:FAIR, KATHY M (ARNP)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:M
Last Name:FAIR
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:KATHY
Other - Middle Name:M
Other - Last Name:VIOLINO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNM,ARNP
Mailing Address - Street 1:900 GLADES RD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-6421
Mailing Address - Country:US
Mailing Address - Phone:561-430-3933
Mailing Address - Fax:561-430-3943
Practice Address - Street 1:900 GLADES RD
Practice Address - Street 2:SUITE 4
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-6421
Practice Address - Country:US
Practice Address - Phone:561-430-3933
Practice Address - Fax:561-430-3943
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2014-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2151572363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner