Individual
MRS. JOANNE FAIRLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
14116 CUSTOMS BLVD, GULFPORT, MS 39503-5164
(601) 957-6300
Mailing address
7755 CENTER AVE, STE 630, HUNTINGTON BEACH, CA 92647-9152
(657) 400-5180
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
281478
AZ
363L00000X
Nurse Practitioner
R781853
MS
363LG0600X
Gerontology Nurse Practitioner
R781853
MS
Other
Enumeration date
06/13/2015
Last updated
10/04/2022
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