MRS. JOANNE FAIRLEY (NPI# 1972984136) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1972984136 |
| Entity Type | Individual |
| Full Name | MRS. JOANNE FAIRLEY |
| Other Name | PROF. JOANNA FAIRLEY |
| Credential | NP |
| Practice Address |
14116 Customs Blvd Gulfport MS 39503-5164 |
| Mailing Address |
7755 Center Ave Ste 630 Huntington Beach CA 92647-9152 |
| Practice Telephone | 6019576300 |
| Mailing Telephone | 6574005180 |
| Enumeration Date | 2015-06-13 |
| Last Update Date | 2019-10-25 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363L00000X | Nurse Practitioner | R781853 | MS | Physician Assistants & Advanced Practice Nursing Providers |
| N | 363LG0600X |
Nurse Practitioner Specialization: Gerontology |
R781853 | MS | Physician Assistants & Advanced Practice Nursing Providers |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 1 Galleria Blvd # 1420, Metairie, LA 700012082 | 8333625364 | |
| 4201 Coventry Dr, Moss Point, MS 395628026 | 2282353173 |
| Street Address |
14116 CUSTOMS BLVD |
| City | GULFPORT |
| State | MS |
| Zip Code | 39503-5164 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073551511 | Daniel Salmeron | Family Medicine | 14116 Customs Blvd, Gulfport, MS 39503-5164 | 2006-06-04 |
| 1013473610 | Corschika Henry Hart | Nurse Practitioner | 14116 Customs Blvd, Gulfport, MS 39503-5164 | 2019-02-19 |
| 1053818245 | Landmark Medical of Mississippi PC | General Practice | 14116 Customs Blvd, Gulfport, MS 39503-5164 | 2018-04-12 |
| 1396295382 | Bonnie Rosenthal | Nurse Practitioner | 14116 Customs Blvd, Gulfport, MS 39503-5164 | 2016-10-13 |
| 1295107357 | Tammy Vincent | Nurse Practitioner | 14116 Customs Blvd, Gulfport, MS 39503-5164 | 2015-10-28 |
| 1356781819 | Randal Herbert | Nurse Practitioner | 14116 Customs Blvd, Gulfport, MS 39503-5164 | 2013-06-28 |
| 1952649774 | Jamie Robinson | Nurse Practitioner | 14116 Customs Blvd, Gulfport, MS 39503-5164 | 2013-01-29 |
| 1366616344 | Amber Martin Arnold | Nurse Practitioner | 14116 Customs Blvd, Gulfport, MS 39503-5164 | 2008-04-21 |
| 1811079544 | Debra B Baxter | Nurse Practitioner | 14116 Customs Blvd, Gulfport, MS 39503-5164 | 2006-10-20 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013515451 | Gulf Coast Neurospa, LLC | Psychiatry & Neurology | 8845 Lorraine Road, Gulfport, MS 39503 | 2020-10-16 |
| 1447865985 | Nicholas Wyrosdick | Physical Therapist | 12261 Us 49 #1, Gulfport, MS 39503 | 2020-09-11 |
| 1750935169 | Ladner Roy Drugs, LLC. | Pharmacy | 12261 Us 49 Suite 16, Gulfport, MS 39503 | 2019-07-25 |
| 1528559440 | Alexander Therapy Services, LLC | Clinic/Center | 15465 Oak Ln Ste 100c, Gulfport, MS 39503 | 2018-05-25 |
| 1750879003 | Heather Lynn Theisen | Nurse Practitioner | 15190 Community Rd Ste 330, Gulfport, MS 39503 | 2018-04-23 |
| 1083101216 | Gulf Coast Mental Health Center | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 15094 County Barn Road, Gulfport, MS 39503 | 2018-04-13 |
| 1306343173 | Dr. Raymond Monsour Scurfield, LLC | Community/Behavioral Health | 15465 Oak Lane Ste 100-g, Gulfport, MS 39503 | 2018-04-09 |
| 1952817157 | Mary Beth Welch | Behavioral Analyst | 9230 Old Lorraine Rd, Gulfport, MS 39503 | 2017-12-26 |
| 1831603257 | Beach View Family Dental, Pllc | Dentist | 9072 Lorraine Road, Gulfport, MS 39503 | 2017-11-21 |
| 1437677721 | Mary Stephens Ruffin | Social Worker | 11262 Creek Dr, Gulfport, MS 39503 | 2017-09-07 |
| Find all providers in zip 39503 | ||||
| Taxonomy Code | 363L00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| (1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners. |
| Notes: Source: (1) American Nurses’ Association, American Nurses Credentialing Center, 1996 Certification Catalogue. (2) ) Lexikon: Dictionary of Health Care Terms, Organizations and Acronyms for the Era of Reform, The Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, Illinois: 1994, p. 549. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356960777 | Jennifer M Hunter | Nurse Practitioner | 8970 Lorraine Rd, Gulfport, MS 39503-4176 | 2020-04-15 |
| 1831720242 | Amanda R Woodcock | Nurse Practitioner | 1391 Broad Ave Ste A, Gulfport, MS 39501-2419 | 2020-02-04 |
| 1528428182 | Teresa Kay Guy | Nurse Practitioner | 6107 Kipps Colony Dr W, Gulfport, FL 33707-3969 | 2016-02-25 |
| 1255608816 | 828 Walk In Clinic | Nurse Practitioner | 12207 Hwy 49, Suite 40, Gulfport, MS 39503 | 2011-11-28 |
| 1326343484 | Kelli Michelle Garrigues | Nurse Practitioner | 1110 Broad Ave Ste 700, Gulfport, MS 39501-8908 | 2011-01-21 |
| 1386815694 | Heather Nicole Swann | Nurse Practitioner | 4333 15th St Ste B, Gulfport, MS 39501 | 2008-03-13 |
| 1013064245 | Leigh P Drace | Nurse Practitioner | 394 Courthouse Rd Ste A, Gulfport, MS 39507-1866 | 2007-01-03 |
| 1801987870 | Primesource Nursing Services, Inc | Nurse Practitioner | 4906 Kendall Ave, Gulfport, MS 39507-4409 | 2006-09-27 |
| 1659477693 | Gary Dalton Gentry | Nurse Practitioner | 4500 13th Street, Wound Care, Gulfport, MS 39501 | 2006-09-16 |
| 1487673406 | Katherine P Griffis | Nurse Practitioner | 38 Pass Rd Ste A, Gulfport, MS 39507-3107 | 2006-07-19 |
| Find all providers in GULFPORT | ||||
Please comment or provide details below to improve the information on MRS. JOANNE FAIRLEY.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.