MEDICARE: JOSELYN ELISE FAIR FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	23102	SC

General Provider Information

NPI Number	:	1851800148
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSELYN ELISE FAIR FNP

Provider Business Mailing Address
First Line	:	PO BOX 21890
Second Line	:
City	:	BELFAST
State	:	ME
Zip	:	04915-4115
Country	:	US
Telephone Number	:	502-907-0356
Fax Number	:	502-919-9780

Provider Business Practice Location Address
First Line	:	7021 SAINT ANDREWS RD STE 1
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29212-1177
Country	:	US
Telephone Number	:	803-791-7175
Fax Number	:	803-791-7176

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/29/2017
Last Update Date	:	08/14/2025

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