Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 04366 | KY |
N | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | 04366 | KY |
NPI | 1124474903 |
---|---|
Provider Name | Brittany Ann Nicole Fairchild |
First Address | Paintsville, KY 41240-1384 |
Second Address | Paintsville, KY 41240-1384 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/05/2016 |
Last Update Date | 05/06/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7100550950 | (05) | KY |