Provider Demographics
NPI:1861461519
Name:GARRIGUES-FAIRBANK, KRISTIN J
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:J
Last Name:GARRIGUES-FAIRBANK
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 1:1341 COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:HAYS
Mailing Address - State:KS
Mailing Address - Zip Code:67601-9217
Mailing Address - Country:US
Mailing Address - Phone:785-259-0613
Mailing Address - Fax:
Practice Address - Street 1:1341 COLLEGE ST
Practice Address - Street 2:
Practice Address - City:HAYS
Practice Address - State:KS
Practice Address - Zip Code:67601-9217
Practice Address - Country:US
Practice Address - Phone:785-259-0613
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-15
Last Update Date:2014-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100284760BMedicaid