Individual
MS. JENNIFER FAIRCLOTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
2511 DELANEY AVE, WILMINGTON, NC 28403-6003
(910) 667-9328
Mailing address
PO BOX 40908, FAYETTEVILLE, NC 28309-0908
(910) 615-6448
(910) 615-5070
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
159820
NC
367500000X
Certified Registered Nurse Anesthetist
4029912
KY
367500000X
Certified Registered Nurse Anesthetist
AP61525326
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PENDING
—
NC
Enumeration date
09/15/2009
Last updated
03/21/2025
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