Provider Demographics
NPI:1962036558
Name:HAIR, KEVIN LEE (NP-C)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:LEE
Last Name:HAIR
Suffix:
Gender:M
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10490 N US HIGHWAY 41
Mailing Address - Street 2:
Mailing Address - City:ROSEDALE
Mailing Address - State:IN
Mailing Address - Zip Code:47874-9126
Mailing Address - Country:US
Mailing Address - Phone:812-249-8142
Mailing Address - Fax:
Practice Address - Street 1:1 PHIPPS LN
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:IL
Practice Address - Zip Code:61944-2919
Practice Address - Country:US
Practice Address - Phone:217-463-4340
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-24
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28167157A363LF0000X
IL209020837363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily