Faircloth, John Myron

Faircloth, John Myron is an individual health care provider with primary practice located at 127 E Redstone Ave Ste C , Crestview FL 32539-5356. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Family, which is considered as his primary health care specialty. Faircloth, John Myron can be contacted via phone (850) 423-0061.

Contact Information

Primary practice address
127 E Redstone Ave Ste C Crestview FL 32539-5356
Phone: (850) 423-0061
Fax: (850) 423-9954
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X 0103219 Georgia
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X ARNP9470257 Florida

Profile Details

NPI number 1063543890
LBN Legal business name Faircloth, John Myron
Credentials Nurse Practitioner (NP)
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 7th, 2007
Last updated Sep 10th, 2020 - about 4 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1063543890 NPPES
Georgia MEDICAID 000946547B

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