| Doctor Name: | MRS. JOANNE FAIRLEY |
| NPI Number: | 1972984136 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | NP |
| License Number: | R781853 |
| Business Practice Address: | 4201 Coventry Dr Moss Point, MS - 395628026 |
| Business Phone Number: | 2282353173 |
| Business Fax Number: | |
| Mailing Address: | 5001 Statesman Dr, IRVING |
| State: | TX |
| Postal Code: | 750632414 |
| Phone Number: | 9725055711 |
| Fax Number: | |
| NPI Enumeration Date: | 06/13/2015 |
| NPI Last Update Date: | 06/03/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LG0600X |
| License Number: | R781853 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | MS |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Gerontology |
| Taxonomy Definition: | |