Provider Demographics
NPI:1326643164
Name:FAIRCLOTH, DEBORAH JUNE
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:JUNE
Last Name:FAIRCLOTH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:146 MILITARY AVE
Mailing Address - Street 2:
Mailing Address - City:BUNKER HILL
Mailing Address - State:WV
Mailing Address - Zip Code:25413-2574
Mailing Address - Country:US
Mailing Address - Phone:304-229-5121
Mailing Address - Fax:304-471-2488
Practice Address - Street 1:397 MID ATLANTIC PKWY STE 1
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25404-7468
Practice Address - Country:US
Practice Address - Phone:304-267-3997
Practice Address - Fax:304-267-5882
Is Sole Proprietor?:No
Enumeration Date:2020-12-01
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker