Individual
MARK FAIRCHILD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PAC
Contact information
Practice address
211 KY 59, VANCEBURG, KY 41179-9701
(606) 796-3029
(606) 796-6221
Mailing address
PO BOX 550, VANCEBURG, KY 41179-0550
(606) 796-3029
(606) 796-6221
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA434
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
95002721
—
KY
Enumeration date
02/08/2006
Last updated
06/24/2010
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