Provider Demographics
NPI:1063637031
Name:FAIR, KATHY M (ARNP)
Entity type:Individual
Prefix:
First Name:KATHY
Middle Name:M
Last Name:FAIR
Suffix:
Gender:
Credentials:ARNP
Other - Prefix:
Other - First Name:KATHY
Other - Middle Name:M
Other - Last Name:VIOLINO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNM,ARNP
Mailing Address - Street 1:900 GLADES RD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-6421
Mailing Address - Country:US
Mailing Address - Phone:561-430-3933
Mailing Address - Fax:561-430-3943
Practice Address - Street 1:900 GLADES RD
Practice Address - Street 2:SUITE 4
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-6421
Practice Address - Country:US
Practice Address - Phone:561-430-3933
Practice Address - Fax:561-430-3943
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN2151572367A00000X
FLARNP2151572363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife