Provider Demographics
NPI:1972589570
Name:HAIRSTON, VERNITA D (MD)
Entity Type:Individual
Prefix:DR
First Name:VERNITA
Middle Name:D
Last Name:HAIRSTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:VERNITA
Other - Middle Name:D
Other - Last Name:HAIRSTON-MITCHELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 843966
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64184-3966
Mailing Address - Country:US
Mailing Address - Phone:573-884-3300
Mailing Address - Fax:573-884-0943
Practice Address - Street 1:1020 HITT ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65212-0001
Practice Address - Country:US
Practice Address - Phone:573-882-1515
Practice Address - Fax:573-884-0070
Is Sole Proprietor?:No
Enumeration Date:2005-12-16
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20001750932081P0004X, 2084N0400X
KS04-365722081P0004X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2081P0004XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSpinal Cord Injury Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO205177405Medicaid
MO263A929AMedicare ID - Type UnspecifiedMEDICARE NUMBER
MO205177405Medicaid