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General NPI Number Information
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NPI Number | 1891409470
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Entity Type | Individual
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Provider Name | BRITTANY K FAIR PA
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Gender | Female
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Dates
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Enumeration Date | 01/09/2023
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Last Update Date | 01/09/2023
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Provider Practice Location Address
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Address Line | 201 S BAY DR
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City | BAY
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State | AR
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Zip | 72411-9482
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Country | US
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Telephone | 870-770-1920
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Fax |
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Provider Business Mailing Address
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Address Line | 4196 HIGHWAY 62 412
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City | HARDY
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State | AR
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Zip | 72542-8002
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Country | US
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Telephone |
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PT2023-002
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License Number State | AR
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