Individual
MRS. REBECCA PATRICIA FAIRLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
2500 N STATE ST, PFS, JACKSON, MS 39216-4500
(601) 984-4619
(601) 948-4657
Mailing address
109 LAKE HILL PL, BRANDON, MS 39047-8237
(601) 259-3217
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
R594792
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00113607
—
MS
Enumeration date
10/25/2006
Last updated
12/21/2010
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