Healthcare Provider Details

I. General information

NPI: 1639653165
Provider Name (Legal Business Name): PATRICK FAIR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2018
Last Update Date: 10/19/2020
Certification Date: 10/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2377 FAIRVIEW BLVD
FAIRVIEW TN
37062-6003
US

IV. Provider business mailing address

1529 57TH AVE N
NASHVILLE TN
37209-1459
US

V. Phone/Fax

Practice location:
  • Phone: 615-799-0101
  • Fax: 615-266-2945
Mailing address:
  • Phone: 615-812-8927
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number24252
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number24252
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: