Provider Demographics
NPI:1154427847
Name:HAIR, KEVIN K (CRNA)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:K
Last Name:HAIR
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1014 E 220 N
Mailing Address - Street 2:
Mailing Address - City:AMERICAN FORK
Mailing Address - State:UT
Mailing Address - Zip Code:84003-2962
Mailing Address - Country:US
Mailing Address - Phone:801-763-5461
Mailing Address - Fax:
Practice Address - Street 1:1014 E 220 N
Practice Address - Street 2:
Practice Address - City:AMERICAN FORK
Practice Address - State:UT
Practice Address - Zip Code:84003-2962
Practice Address - Country:US
Practice Address - Phone:801-763-5461
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT191761-4406367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT01917614401001OtherBCBS
UTPRA04308OtherMOLINA
UTQM0000054865OtherALTIUS
UT660758OtherDESERET MUTUAL
UT66111OtherPEHP
UT107009408102OtherIHC
UT93654OtherHEALTHY U
UT01917614401001OtherBCBS