Individual
PATSY J FAIRCHILD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
221 W MAPLE AVE, FAYETTEVILLE, WV 25840-1413
(304) 574-3960
(304) 574-2179
Mailing address
PO BOX 337, SCARBRO, WV 25917-0337
(304) 469-2905
(304) 465-3180
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
01218
WV
363A00000X
Physician Assistant
387
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001969193
MS BCBS
WV
01
—
01218
LICENSE
WV
05
—
3810007348
—
WV
Enumeration date
10/10/2006
Last updated
09/07/2011
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