Individual
MRS. BROOKE L. FAIR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
816 E. MAIN, WILLOW SPRINGS, MO 65793-1597
(417) 269-2490
(417) 269-2492
Mailing address
3800 S. NATIONAL AVE, STE. 540, SPRINGFIELD, MO 65807-5284
(417) 269-2490
(417) 269-2492
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
154917
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1265666093
—
MO
01
—
26-8535
RH MEDICARE
MO
01
—
26D0889777
CLIA
MO
01
—
597780303
RH MEDICAID
MO
Enumeration date
05/07/2009
Last updated
12/04/2012
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