Provider Demographics
NPI:1528305166
Name:BAIR, KRISTEN (PSYD)
Entity type:Individual
Prefix:DR
First Name:KRISTEN
Middle Name:
Last Name:BAIR
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4605 SPLIT RAIL DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28412-5204
Mailing Address - Country:US
Mailing Address - Phone:954-240-1484
Mailing Address - Fax:
Practice Address - Street 1:1200 SE MAYNARD RD
Practice Address - Street 2:SUITE 202
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511
Practice Address - Country:US
Practice Address - Phone:954-240-1484
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-15
Last Update Date:2018-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4806103T00000X, 103TC0700X, 103TC0700X
FLPY8703103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist