Healthcare Provider Details

I. General information

NPI: 1194771006
Provider Name (Legal Business Name): KARANA R. FAIRLEY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 03/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3105 W 15TH ST SUITE B
PLANO TX
75075-7700
US

IV. Provider business mailing address

3105 W 15TH ST SUITE B
PLANO TX
75075-7700
US

V. Phone/Fax

Practice location:
  • Phone: 972-612-6900
  • Fax: 972-612-6934
Mailing address:
  • Phone: 972-612-6900
  • Fax: 972-612-6934

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberL0160
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code173000000X
TaxonomyLegal Medicine
License NumberL0160
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: