Provider Demographics
NPI:1518621200
Name:FAIRLEY, VALENCIA VESHELLE (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:VALENCIA
Middle Name:VESHELLE
Last Name:FAIRLEY
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 ADMIRAL COCHRANE DR
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-7316
Mailing Address - Country:US
Mailing Address - Phone:228-324-7826
Mailing Address - Fax:
Practice Address - Street 1:175 ADMIRAL COCHRANE DR
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-7316
Practice Address - Country:US
Practice Address - Phone:228-324-7826
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-28
Last Update Date:2022-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS905320363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health