Healthcare Provider Details

I. General information

NPI: 1538024500
Provider Name (Legal Business Name): KRISTY DAWN FAIR DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2025
Last Update Date: 12/22/2025
Certification Date: 12/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 S HARPER RD
CORINTH MS
38834-6646
US

IV. Provider business mailing address

535 TULU LN
MICHIE TN
38357-5018
US

V. Phone/Fax

Practice location:
  • Phone: 662-293-1405
  • Fax:
Mailing address:
  • Phone: 731-607-1459
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number16858
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: