Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 2021022625 | MO |
Y | 207Q00000X | Family Doctor | 9409365 | KS |
NPI | 1003348095 |
---|---|
Provider Name | Chelsea Fair |
First Address | Spring Hill, KS 66083-8554 |
Second Address | Kansas City, MO 64139-1236 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/03/2017 |
Last Update Date | 19/07/2021 |