Provider Demographics
NPI:1942092705
Name:BAIR, COREY MICHAEL (FNP-C)
Entity type:Individual
Prefix:MR
First Name:COREY
Middle Name:MICHAEL
Last Name:BAIR
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:251 FRONT ST STE 10
Mailing Address - Street 2:
Mailing Address - City:MONUMENT
Mailing Address - State:CO
Mailing Address - Zip Code:80132-9137
Mailing Address - Country:US
Mailing Address - Phone:719-481-3121
Mailing Address - Fax:
Practice Address - Street 1:251 FRONT ST STE 10
Practice Address - Street 2:
Practice Address - City:MONUMENT
Practice Address - State:CO
Practice Address - Zip Code:80132-9137
Practice Address - Country:US
Practice Address - Phone:719-481-3121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-19
Last Update Date:2025-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COF05250322363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily