Individual
MICHAEL W FAIRBANKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
FNP
Contact information
Practice address
2490 PASS RD, BILOXI, MS 39531-2838
(228) 207-9967
(228) 273-1532
Mailing address
7421 JOE FOUNTAIN RD, OCEAN SPRINGS, MS 39564-9626
(228) 238-9149
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
1-066504
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02672857
—
MS
01
—
1-066504
NURSE PRACTITIONERS
AL
01
—
811413110
TAX ID
MS
01
—
900279914
MS PHYSICIAN CARE NETWORK
MS
01
—
900279914
UNITED HEALTH CARE
—
Enumeration date
08/12/2006
Last updated
06/27/2016
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