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NPI Code Detail

MEDICARE: MRS. JOANNE FAIRLEY NP

MEDICARE: MRS. JOANNE FAIRLEY NP
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
1363L00000XNurse PractitionerR781853MS
2363LG0600XGerontology Nurse PractitionerR781853MS
3363L00000XNurse Practitioner281478AZ

General Provider Information

NPI Number : 1972984136
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. JOANNE FAIRLEY NP
Provider Business Mailing Address
First Line : 7755 CENTER AVE
Second Line : STE 630
City : HUNTINGTON BEACH
State : CA
Zip : 92647-9152
Country : US
Telephone Number : 657-400-5180
Fax Number :
Provider Business Practice Location Address
First Line : 14116 CUSTOMS BLVD
Second Line :
City : GULFPORT
State : MS
Zip : 39503-5164
Country : US
Telephone Number : 601-957-6300
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/13/2015
Last Update Date : 10/04/2022

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