| Doctor Name: | MARK FAIRCHILD |
| NPI Number: | 1255304598 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PAC |
| License Number: | PA434 |
| Business Practice Address: | 211 Ky 59 Vanceburg, KY - 411799701 |
| Business Phone Number: | 6067963029 |
| Business Fax Number: | 6067966221 |
| Mailing Address: | Po Box 550, VANCEBURG |
| State: | KY |
| Postal Code: | 411790550 |
| Phone Number: | 6067963029 |
| Fax Number: | 6067966221 |
| NPI Enumeration Date: | 02/08/2006 |
| NPI Last Update Date: | 06/24/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | PA434 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | KY |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |