Healthcare Provider Details

I. General information

NPI: 1427962125
Provider Name (Legal Business Name): CARRIE GRACE FAIRLEY CPSS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

57 INDUSTRIAL PARK RD
LUCEDALE MS
39452-6583
US

IV. Provider business mailing address

57 INDUSTRIAL PARK RD
LUCEDALE MS
39452-6583
US

V. Phone/Fax

Practice location:
  • Phone: 601-495-3010
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: