Doctor Name: | KEVIN M FAIRLEY |
NPI Number: | 1043497670 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | APN-BC |
License Number: | 254740 |
Business Practice Address: | 45 Georgian Rd Weston, MA - 024932110 |
Business Phone Number: | 7816428618 |
Business Fax Number: | 7813988341 |
Mailing Address: | 45 Georgian Rd, WESTON |
State: | MA |
Postal Code: | 024932110 |
Phone Number: | 7816428618 |
Fax Number: | 7813988341 |
NPI Enumeration Date: | 01/25/2008 |
NPI Last Update Date: | 01/25/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LA2200X |
License Number: | 254740 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MA |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Adult Health |
Taxonomy Definition: |