| Doctor Name: | MRS. VICKY LYNNE FAIREY |
| NPI Number: | 1710006101 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | RN,C |
| License Number: | 142179 |
| Business Practice Address: | Highway J North Box 441 Hayti, MO - 63851 |
| Business Phone Number: | 5733592600 |
| Business Fax Number: | |
| Mailing Address: | 943 Jefferson Ave, CARUTHERSVILLE |
| State: | MO |
| Postal Code: | 638301757 |
| Phone Number: | 5733332894 |
| Fax Number: | 5733332607 |
| NPI Enumeration Date: | 03/28/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 163WA0400X |
| License Number: | 142179 |
| Healthcare Provider Taxonomy: (Secondary) | X |
| State: | MO |
| Taxonomy Type: | Nursing Service Providers |
| Taxonomy Classification: | Registered Nurse |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |