Provider Demographics
NPI:1942268206
Name:HALSEY, KEVIN (MD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:
Last Name:HALSEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
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Mailing Address - Street 1:210 PORTLAND ST STE 100
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201-6677
Mailing Address - Country:US
Mailing Address - Phone:573-777-8818
Mailing Address - Fax:573-777-8819
Practice Address - Street 1:210 PORTLAND ST STE 100
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-6677
Practice Address - Country:US
Practice Address - Phone:573-777-8818
Practice Address - Fax:573-777-8819
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007010295207RG0100X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO207537804Medicaid
MO207537804Medicaid
MOX43F478Medicare Oscar/Certification