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General NPI Number Information
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NPI Number | 1265760060
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Entity Type | Individual
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Provider Name | KAREN S FAIRCLOTH NP
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Gender | Female
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Dates
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Enumeration Date | 12/07/2009
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Last Update Date | 12/07/2009
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Provider Practice Location Address
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Address Line | 2805 DR JOHN HAYNES DR
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City | PELL CITY
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State | AL
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Zip | 35125-1448
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Country | US
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Telephone | 866-313-5260
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Fax | 205-313-5245
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Provider Business Mailing Address
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Address Line | 333 CASTLEMAN LN
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City | LEEDS
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State | AL
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Zip | 35094-3856
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Country | US
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Telephone | 205-699-6215
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 1-030650
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License Number State | AL
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